微创内固定系统治疗复杂胫骨近端骨折.docVIP

微创内固定系统治疗复杂胫骨近端骨折 　 作者：李喜功，孙俊英，徐耀增，唐祖林，杨兴，耿德春，朱若夫 【摘要】 ［目的］总结微创内固定系统(LISS)治疗复杂的胫骨近端骨折疗效，探讨LISS的理念及操作技术。［方法］2004年1月～2006年3月应用微创内固定系统治疗复杂的胫骨近端骨折39例，其中男26例，女13例；平均34.8岁（22～54岁）。按AO/OTA分型：41-A3型19例,41-C2型12例，41-C3型4例,累及近端42型4例。其中7例为开放性损伤（Gustilo Ⅰ型3例，Ⅱ型4例）。11例合并有其它部位骨折。［结果］所有患者均得到随访，平均随访15.6个月（10～21个月）。平均手术时间75 min(60～130 min)。平均失血量300 ml(170～500 ml)。所有骨折均愈合，平均愈合时间13周（11～16周）。其中33例对线良好，5例在冠状面上有6°～8°外翻成角，1例5°内翻成角；患者完全负重时间平均14.2周（11～18周）；膝关节活动范围为100°～120°；所有病例无感染、断钉、钢板断裂、固定失效等并发症。按照HSS评分：优26例,良7例，中5,差1例，优良率84.6％。［结论］微创内固定系统固定牢靠，能够促进骨折早期愈合和功能恢复，是治疗复杂的胫骨近端骨折的理想疗法。正确认识LISS理念及操作原则，并根据具体病例进行调整，是成功治疗的关键。 【关键词】 胫骨近端骨折； 骨折固定术； 微创内固定系统 Abstract：［Objective］To summarize results of treating complex proximal tibia fractures with less invasive stabilization system(LISS)，and to explore the concept and technology of LISS.［Method］From January 2004 to March 2006,39 cases of complex proximal tibia fractures were treated with less invasive stabilization system,including 26 male and 13 female.The mean age of the patients was 34.8 years (range 22 to 54 years).According to the AO/OTA fracture classification,there were 19 cases in type 41-A3,12 cases in type 41-C2,4 cases in type 41-C3,4 cases in proximal type 42.Seven cases were open fractures and were classified as 3 grade Ⅰ,4 grade Ⅱ open fracture according to the system of Gustilo.Eleven patients were multitraumatic patients.［Result］All the cases were followed up for averaging 15.6 months ( 10～21 months).The mean operation time was 75 min（60～130 min）.All fractures healed,the averaging healing time was 13 weeks(11～16weeks).The averaging blood lost was 300 ml(170～500 ml).The postoperative alignment of 33 fractures was satisfactory， 5 cases had 6°～ 8 °valgus auglation,one case had 5°varus auglation in coronal plane.The mean time of weight bearing was 14.2 weeks(11～18 weeks).The range of movement was 100°～120°.All the cases had no infection,breakage of screws and plates,failed fixation and so on.According to HSS scores system,there were 26 exc