Wenda K, Runkel M, Degreif J, Rudig L
Klinik für Unfall- und Wiederherstellungschirurgie, Dr. Horst-Schmidt-Kliniken Wiesbaden, Germany.
Injury. 1997;28 Suppl 1:A13-9. doi: 10.1016/s0020-1383(97)90111-x.
Bridge-plating with its advantages in terms of vascularity and bone healing is a well established procedure today in the treatment of comminuted femoral fractures. Bridge-plating means that the fracture site is not interfered with during the operative procedure. This paper introduces a surgical technique in which the plate is inserted through isolated proximal and distal incisions only, behind the vastus lateralis. Alignment is secured by the plates, the fracture site remains untouched, fixation and screw insertion is restricted to the proximal and distal main fragments. Longitudinal femoral fractures extending right into the trochanteric and or condylar areas are the main indication for minimally invasive plate fixations with angled blade plates or condylar screws since fractures which are restricted to the diaphyseal area are mostly treated by nailing today. The surgical trauma resulting from plating by proximal and distal incisions only is less than that associated with conventional techniques. Indirect reduction of femoral fragments is much easier since the integrity of the surrounding muscles and soft tissue is preserved, the fragments often being reduced simply by traction. Adjustment of rotation is an essential aspect requiring careful attention. For special indications, namely comminuted fractures affecting a large part of the femur and extending into the trochanteric or condylar areas, insertion of the plate via proximal and distal incisions only is a further development in bridge-plating which minimizes surgical trauma and operation time.
桥接钢板固定术在血运和骨愈合方面具有优势，是目前治疗股骨粉碎性骨折的成熟方法。桥接钢板固定术意味着在手术过程中不干扰骨折部位。本文介绍一种手术技术，即仅通过孤立的近端和远端切口，在股外侧肌后方插入钢板。钢板确保骨折对线，骨折部位保持未受干扰，固定和螺钉插入仅限于近端和远端主要骨折块。延伸至转子区和/或髁区的股骨纵向骨折是使用角向钢板或髁螺钉进行微创钢板固定的主要适应证，因为目前局限于骨干区域的骨折大多采用髓内钉治疗。仅通过近端和远端切口进行钢板固定所产生的手术创伤小于传统技术。由于保留了周围肌肉和软组织的完整性，股骨骨折块的间接复位要容易得多，骨折块通常仅通过牵引即可复位。旋转调整是一个需要仔细关注的重要方面。对于特殊适应证，即累及股骨大部分并延伸至转子区或髁区的粉碎性骨折，仅通过近端和远端切口插入钢板是桥接钢板固定术的进一步发展，可将手术创伤和手术时间降至最低。
