鎖定钢板要点与技巧.docVIP

Locking Plates: Tips and TricksWade R. Smith, MD, Bruce H. Ziran, MD, Jeff O. Anglen, MD锁定钢板：要点与技巧Locking plates are fracture fixation devices with threaded screw holes, which allow screws to thread to the plate and function as a fixed-angle device1-3. These plates may have a mixture of holes that allow placement of both locking and traditional nonlocking screws (so-called combi plates)4,5. The first locking plates were introduced about two decades ago for use in spinal and maxillo-facial surgery6-8. In the late 1980s and into the 1990s,experimentation with various types of internal fixation devices led to the development of locking plates for fracture care9-11. The initial emphasis was on developing stable fixation that would not require extensive soft-tissue stripping or disruption12. The clinical care impetus for development of these plates has been a combination of factors, including the increasing survival of patients with high-energy injuries, aging Western European and North American populations with an increasing rate of fragility fractures, and dissatisfaction of patients and surgeons with the outcomes of treatment of specific periarticular fractures. Nonclinical factors likely include a push by industry for new technology and new markets as well as the general interest of the public in “minimally invasive” surgery.所谓锁定钢板是一种带有螺纹孔的骨折固定装置，此孔在有螺纹头的螺钉拧入后，钢板就变为一种（螺钉）角度固定装置。锁定钢板可同时具有锁定及非锁定螺孔以供不同螺钉拧入（又叫结合钢板）。在大约20年前锁定钢板被首次引入，用于脊柱以及颌面部手术。在20世纪80年代末至90年代，关于不同种类的内固定装置的实验研究将锁定钢板引入了骨折治疗之中。发展出这种牢固固定方式的初衷是为避免广泛的软组织剥离。多种因素共同推进了这种钢板在临床上的使用，包括随着高能量损伤患者的生存率提高以及在西欧以及北美高龄骨质疏松患者数量的日益增长，粉碎性骨折的发生率不断提高；医生以及患者对某些关节周围骨折的治疗效果不满意。其它非临床的促进因素可能有：工业对于新技术及新市场的推动作用；微创外科的逐渐流行等。While locking plates have been used for years in specialized research trials, they have been available in North America for general orthopaedic applications only in the last six or seven years13-15. Currently, numerous companies offer a variety of locking plate systems for treatment of extremity fractures. Many o