微创内固定系统对股骨远端骨折的间接复位作用  

Indirect reduction of distal femur by Less Invasive Stabilization System-Distal Femur plate

作　　者：张力丹[1] 刘洪波[1] 刘国会[1] 张权[1] 刘亚波[1] 张伯松[1] 王满宜[1] 

机构地区：[1]北京积水潭医院创伤骨科,100035

出　　处：《中华创伤骨科杂志》2012年第7期577-581,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨一种利崩AO微创内吲定系统（LISS）钢板的解剖形态设计埘股骨远端骨折进行间接复位的手术方法。方法2002年12月至2006年12月对13例复杂股骨远端骨折患者应用svnthes LISSDF捌解剖锁定钢板对股骨远端骨折进行间接复位固定，均为男性；年龄18～58岁，平均37．1岁。均为新鲜骨折。股骨远端骨折按AO分型：C2型9例，C3型4例。前先将LISS钢板按照其特定的形态放置于股骨外髁特定的位置并进行固定：止位X线片上D、F孔螺钉平行十膝关节面，侧位X线片上连线与股骨外髁氏轴一致；再将钢板近端簧于股骨干外侧、平行于股骨干同定，即利用钢板与锁定螺钉同定的审间形态达到股骨远端骨折间接复位的目的。根据股骨外翻角和Blumensaat线对复化同定后的股骨远端骨折进行测量，评价骨折复位情况。结果13例患者术后获平均18个月（13～36个月）随访。术后3个月骨折愈合率为61．5％（8／13），术后1年所有患者均获骨折愈合。股骨外剁角平均为81．7°±3．50．BIt-rnensaat线与股骨干K轴夹角平均为38．7°±6．0°。术次随访时骨折固定均无继发移位．内Ⅲ定物无失效。采用美国特种外科腻院膝关节评分标准评定疗效：评分平均为76分（42～96分）；其中优3例，良6例，中3例，差1例，优良率为69．2％。结论利用Synthes LISSDF型解剖锁定钢板的解剖形态可实现股骨远端骨折的问接复位和固定，此方法能简化手术步骤．埘失去影像学复他标志的复杂骨折更为有效。Objective To introduce a type of anatomical locking plate （Synthes LISS DF） in the less irwasive stabilization system （LISS） which can have an effect of indirect reduction and fixation on corn- minuted fractures of tile femur. Methods From December 2002 through December 2006, 13 male pa- tients with complicated fresh frcture of the distal femur were treated with Synthes L1SS DF. Their ages ranged from 18 through 58 ）,ears. with an average of 37. I years. First, a specially shaped LISS DF was placed at the femoral external condyle to fixate the distal fenmr. The distal locking screws at tire holes D and F of the I,ISS DF plate were paralleled to the knee joint surface in the anteriorposterior view and the line between the screw holes D and F was kept as long as the axis of the femoral lateral condyle in the lateral view. Next the proximal end of the I,ISS DF was placed at the lateral femur to fixate the femur shaft after traction to restore the length of the femur. After tile fixation like this, the femoral fractures were reduced autonmtically in a functional reduction. The femoral axis orientation and the Blumensaat line were used for evaluation of the reduction. Results All the patients were followed up fro an average of 18 months （from 13 to 36 months）. The fracture united in 61. 5% （8/13） of the patients at 3 months postoperation and in all at 12 months postop- eralion. The average distal femoral axis orientation was 81.7°±3.5° and the average angle between the Blumeusaat line and the long axis of the femoral shaft was 38.7°± 6.0°. The last follow-tip found no secondary displacement of the fi＇acture or no implant failure. By the evaluation system of The Hospital tbr Special Surgery （HSS）, the patients scored 76 on aveerlge （from 42 to 96）. Three cases were rated as excellent, 6 as fine, 3 as fair and one as poor, with a good to excellent rate of 69. 2%. Conclusions LISS DF can be used as a template to fix and reduce sinmhaneously the eomminuted fi＇actures of the distal femur

关 键 词：股骨骨折 骨板 骨折固定术 内 复位 

分 类 号：R687.3[医药卫生—骨科学]