LISS钢板治疗膝关节周围严重粉碎性骨折疗效观察

目的]报告AO微创内固定系统(less invasive stabilization system,LISS)治疗膝关节周围严重粉碎性骨折疗效,探讨手术相关问题和分析术后并发症的原因.方法]2004年10月-2007年8月应用LISS钢板治疗膝关节周围严重粉碎性骨折69例,其中股骨骨折38例,胫骨骨折31例.合并髌骨骨折5例,伴其他部位骨折16例.按AO/OTA分型,股骨骨折中,33-A3型7例;33-C2型16例,33-C3型15例;胫骨骨折中,41-A3型12例,41-B2型10例,41-C2型9例.结果]全部病例获得随访,平均随访时间14.5个月(12～36个月),平均手术时间90 min(75～130 min),术中平均失血量350 ml(200～750 ml).术后伤口均I期愈合,1例膝内翻畸形,1例肢体短缩,2例内固定激惹,2例骨延迟愈合,2例内固定取出困难.膝关节功能HSS评分优良率89.9%.结论]LISS钢板是治疗膝关节周围严重粉碎性骨折的理想内固定材料.明确手术适应证,严格掌握操作程序和重视对骨缺损的处理是取得满意疗效的关键.

Observation of curative effect of comminuted fractures around knee joint treated with less invasive stabilization system

Objective]To report the curative effect of comminuted fractures around knee joint treated with less invasive stabilization system (LISS) and to focal point to the correlated problems of operations and complications. Method] The comminuted fractures around knee joint were treated with LISS in 69 cases from October 2004 to August 2007. There were femoral fractures in 38 cases,tibial fractures in 31 cases,accompanying patellar fractures in 5 cases and with other fractures in 16 cases. According to AO/OTA criteria,the femoral fractures were 7 type 33 - A3,16 type 33 — C2,15 type 33 - C3 and the tibial fractures were 12 type 41 - A3,10 type 41 - B2,9 type 41 - C2. Result] All cases were followed up for 14.5 months in average. The average time of the operations was 90 min and the average blood losing was 350 ml. All wounds recovered in I stage but 1 case with bandy-leg, 1 case with limb shortening,2 cases with internal fixation irritation and 2 cases with bone late healed and 2 cases with difficulty of taking out of the internal fixations. The satisfactory rate were 89.9% according to HSS knee scoring. Conclusion] LISS is an ideal internal fixation material for treating the severity comminuted fractures around knee joint,but the operators should strictly handle the indications and operative procedures and pay attention to the bone defects to achieve satisfactory effect.