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微创稳定系统和解剖钢板治疗胫骨近端复杂骨折的对比研究

闫旭1,陈新2,石忠琪2,王佳2   

  1. 1. 天津市天津医院
    2. 天津市天津医院创伤骨科
  • 收稿日期:2011-04-21 修回日期:2011-06-09 出版日期:2012-02-15 发布日期:2012-02-15
  • 通讯作者: 闫旭

Comparative Study of Less Invasive Stabilization System (LISS) Fixation and Anatomical Plating for Treatment of Complicated Proximal Tibial Fractures

  • Received:2011-04-21 Revised:2011-06-09 Published:2012-02-15 Online:2012-02-15

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摘要： 摘要 目的：对比研究微创稳定系统（LISS）和传统解剖钢板治疗胫骨近端复杂骨折的临床效果。方法：2002年7月至2008年12月，应用LISS 及传统解剖钢板治疗胫骨近端复杂骨折连续性患者58例。解剖钢板组32例，男21例，女11例；平均41.2岁(23~68岁)；骨折按AO/OTA 分型：A2 型5例，A3 型9例，C2 型16例，C3 型2例。LISS 钢板组26例，男16例，女10例；平均41.5岁（21~61岁）；骨折按AO/OTA 分型：A2 型4例，A3 型7例，C2 型13例，C3 型2例。所有的患者随访12~18个月，比较两组外科手术经验、术后并发症及愈合时间，用改良HSS 评分来评价术后膝关节功能的改善程度。结果：在骨折类型，平均年龄和性别分布上两组患者比较差异无统计学意义。手术时间，手术切口，出血量及12个月HSS 评分比较，LISS 钢板组优于解剖钢板组。解剖钢板组的植骨例数多于LISS 钢板组。放射学愈合时间及术后并发症发生总数在两组比较差异无统计学意义。但LISS 钢板组钢板刺激症状有增高的趋势。结论：LISS及解剖钢板治疗胫骨近端高能量骨折均有较满意效果。但LISS 固定系统具有手术损伤小，术后恢复快等特点，是治疗胫骨近端高能量骨折的新趋势。

关键词: 胫骨近端, 骨折, 微创稳定系统, 解剖钢板

Abstract: Abstract Objective: To study comparatively the clinic outcomes of the treatment of the complicated proximal tibial fractures by the less invasive stabilization system (LISS) or the anatomical plate. Methods: From July 2002 to December 2008, 58 consecutive patients which beared the high energy and complicated proximal tibial fractures were treated with the LISS or anatomical plate. The anatomical plate group has 32 patients. There were 21 males and 11 females, with the average age of 41.2 years (range, 23 to 68 years). The type of AO/OTA concluded the A2 of 5 cases, A3 of 9 cases，C2 of 16 cases and C3 of 2 cases. The LISS plate group has 26 patients. There were 16 males and 10 females, with the average age of 41.5 years (range, 21 to 61 years). The type of AO/OTA concluded the A2 of 4 cases, A3 of 7 cases，C2 of 13 cases and C3 of 2 cases. All patients were followed for 12 to 18 months. Outcomes were assessed by recording the surgical experience, post-operative complications and improvements in knee function as measured by the Hospital for Special Surgery (HSS) scores. Results: No differences in the fracture type, mean age, gender distribution were observed between the two groups. The surgical time, wound size, blood loss and HSS scores of 12 months were significantly difference in the LISS group than in the anatomical plate group. The bone graft was used more frequently in the anatomical plate group. Overall post-operative complications or radiographic healing times were all similar in both groups. A trend toward significance of a higher incidence of symptomatic hardware irritation were observed in the LISS group compared to the anatomical plate group. Conclusion: LISS and the anatomical plate both obtained the satisfactory outcomes in our study. However, LISS was characterized by the less invasion and more excellent recovery, and is new trend for the complicated proximal tibial fractures.

Key words: proximal tibial, fracture, less invasive stabilization system, anatomical plate