中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (30): 5666-5669.doi: 10.3969/j.issn.1673-8225.2010.30.038

• 骨与关节临床实践 clinical practice of the bone and joint • 上一篇    下一篇

三维CT重建基础上经皮插入金属植入物内固定治疗：膝关节周围骨折24例随访

梁英杰，张光明，王建炜，戈  涛   

  1. 广州医学院附属广州市第一人民医院创伤骨科，广东省广州市 510180
  • 出版日期:2010-07-23 发布日期:2010-07-23
  • 通讯作者: 张光明，教授，主任医师，硕士生导师，广州医学院附属广州市第一人民医院，广东省广州市 510180 fmanzhang@163.com
  • 作者简介:梁英杰，男，1980年生，广东省广州市人，汉族，广州市第一人民医院医师，主要从事四肢骨折微创外科治疗的研究。 lyjh@21CN.com

Metal implant internal fixation based on three-dimensional CT reconstruction: Follow-up of 24 patients with fractures around the knee

Liang Ying-jie, Zhang Guang-ming, Wang Jian-wei, Ge Tao   

  1. Department of Traumatology and Orthopedics, Guangzhou First People’s Hospital, Guangzhou Medical University, Guangzhou  510180, Guangdong Province, China
  • Online:2010-07-23 Published:2010-07-23
  • Contact: Zhang Guang-ming, Professor, Chief physician, Master’s supervisor, Department of Traumatology and Orthopedics, Guangzhou First People’s Hospital, Guangzhou Medical University, Guangzhou 510180, Guangdong Province, China fmanzhang@163.com
  • About author:Liang Ying-jie, Physician, Department of Traumatology and Orthopedics, Guangzhou First People’s Hospital, Guangzhou Medical University, Guangzhou 510180, Guangdong Province, China lyjh@21CN.com

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摘要：

背景：膝关节周围骨折早期多采用传统的股骨或胫骨髁钢板、外固定支架及交锁髓内钉固定等治疗，但存在广泛剥离骨折周围软组织，骨折断端局部血运破坏严重，感染机会增大，骨折延迟愈合、不愈合等缺点。
目的：探讨微创内固定系统置入治疗膝关节周围骨折的手术指征、方法及治疗效果。
方法：选择胫骨及股骨骨折患者24例，男17例，女7例；年龄42 (18~60) 岁。在CT三维重建基础上，经皮插入Liss钢板内固定治疗，手术过程均按照Liss内固定系统的标准操作程序完成。置入后4周内每周随访1次，以后每月随访1次。采用国际上通用的美国特种外科医院膝关节功能(HSS)评分法评估效果。
结果与结论：24例患者获6~24个月随访。所有患者均获骨性愈合。HSS评分显示，优18例，良4例，可1例，差1例，优良率92%。结果说明使用Liss微创内固定系统治疗膝关节周围骨折，对膝关节周围软组织损伤小，对骨折端局部微环境干扰小，可最大限度保护骨折端局部血运，感染风险低，内固定可靠，允许患者早期主动功能锻炼，疗效满意。

关键词: 膝关节, 骨折, 外科手术, 微创, 金属植入物, 医学植入物

Abstract:

BACKGROUND: Fractures around the knee have been frequently treated by traditional femoral or tibial plate, external fixator or intramedullary nail fixation. But there are many defects, such as extensive soft tissue stripping around fracture fragments, serious breakdown of the local blood supply, increased risks for infection, delayed union, even nonunion.
OBJECTIVE: To explore the surgical indications, methods and effects of the Liss Invasive Stabilization System (LISS) for fractures around the knee.
METHODS: A total of 24 cases of complex fractures around the knee were selected, including 17 males and 7 females, aged 42 years (18-60 years). They were treated using LISS fixation system based on CT three-dimensional reconstruction. All the operations were performed following AO’s standard operating procedures. After the surgery, the patients were followed-up every week in the first 4 weeks, and then followed-up once a month. Hospital for special surgery knee score (HSS) was used to evaluate the treatment effect.
RESULTS AND CONCLUSION: All patients were followed up for 6-24 months. Fracture healed with no occurrence of nonunion. HSS scores revealed 18 cases of excellent, 4 good, 1 fair and 1 poor, resulting in excellent and good rate of 91.67%. The outcome of using Liss fixation system for treatment of fractures around the knee was satisfactory. The soft tissue injury and the disturbance of the local micro-environment are small. It can maximize the protection of local blood supply of fracture, with low infection, high reliability and early active exercise.

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