Hansen M, Mehler D, Voltmer W, Rommens P M
Klinik für Unfallchirurgie, Johannes Gutenberg-Universität Mainz, Germany.
Unfallchirurg. 2002 Oct;105(10):858-72. doi: 10.1007/s00113-002-0529-x.
Operative stabilization of proximal tibial fractures by use of conventional osteosynthesis is still problematic. The choice of the osteosynthetic treatment is strongly influenced by the situation of the surrounding soft tissue. Additional problems in this particular location may occur with malalignment in the fracture site after operation. Primary intraoperative malalignment may occur due to dislocating muscle forces or to the operative approach itself. Secondary dislocation is mainly due to the unstable fixation of the proximal fragment by the implant. Today many different implants with specific biomechanical properties are available. Each system requires a particular operative technique and can lead to individual implant-related problems. The new angle stable implant systems (e. g. LISS = "less invasive stabilization system"), offer significant advantages over conventional plate osteosyntheses and external fixation systems. Improvement of the geometry of standard intramedullary osteosyntheses and introduction of angle stability in the proximal interlocking screws (PTN = "proximal tibial nail") seemingly make this system the optimal solution, concerning biomechanics. On the background of our own clinical experiences and biomechanical investigations, the article discusses solutions for this particular problem.
采用传统骨固定术对胫骨近端骨折进行手术稳定治疗仍存在问题。骨固定治疗方法的选择受周围软组织状况的影响很大。该特定部位术后可能会出现骨折部位对线不良等其他问题。术中原发性对线不良可能是由于肌肉力量移位或手术入路本身导致的。继发性移位主要是由于植入物对近端骨折块固定不稳定所致。如今有许多具有特定生物力学特性的不同植入物可供使用。每个系统都需要特定的手术技术，并且可能导致与植入物相关的个体问题。新型角度稳定植入系统（例如LISS =“微创稳定系统”）相比传统钢板骨固定术和外固定系统具有显著优势。标准髓内骨固定术几何形状的改进以及近端锁定螺钉（PTN =“胫骨近端髓内钉”）角度稳定性的引入，从生物力学角度来看，似乎使该系统成为最佳解决方案。基于我们自己的临床经验和生物力学研究，本文讨论了针对这一特定问题的解决方案。
