Gautier Emanuel, Sommer Christoph
Department of Orthopaedic Surgery, Kantonsspital Chur, Switzerland.
Injury. 2003 Nov;34 Suppl 2:B63-76. doi: 10.1016/j.injury.2003.09.026.
The Locking Compression Plate (LCP), in combination with the LISS and the PHILOS, is part of a new plate generation requiring an adapted surgical technique and new thinking about commonly used concepts of internal fixation using plates. The following guidelines are needed to avoid failures and possible complications in the hands of surgeons not yet confident with the new implant philosophy. The importance of the reduction technique and minimal-invasive plate insertion and fixation is addressed to keep bone viability undisturbed. Understanding of mechanical background for choosing the proper implant length and the type and number of screws is essential to obtain a sound fixation with a high plate span ratio and a low plate screw density. A high plate span ration decreases the load onto the plate. A high working length of the plate in turn reduces the screw loading, thus fewer screws need to be inserted and the plate screw density can be kept low. Knowledge of the working length of the screw is helpful for the proper choice of monocortical or bicortical screws. Selection is done according to the quality of the bone structure and is important to avoid problems at the screw thread bone interface with potential pullout of screws and secondary displacement. Conclusive rules are given at the end of this chapter.
锁定加压接骨板（LCP）与微创内固定系统（LISS）和近端肱骨锁定接骨板（PHILOS）一样，属于新一代接骨板，需要采用与之适配的手术技术，并对常用的接骨板内固定概念有新的认识。对于尚未熟悉这种新植入理念的外科医生而言，需要遵循以下指导原则以避免手术失败和可能出现的并发症。文中阐述了复位技术以及微创接骨板置入与固定的重要性，以确保骨的活力不受干扰。理解选择合适接骨板长度、螺钉类型和数量的力学背景，对于实现具有高接骨板跨度比和低接骨板螺钉密度的稳固固定至关重要。高接骨板跨度比可降低接骨板上的负荷。接骨板的有效工作长度增加会降低螺钉负荷，进而减少所需置入的螺钉数量，并可保持较低的接骨板螺钉密度。了解螺钉的工作长度有助于正确选择单皮质或双皮质螺钉。应根据骨结构质量进行选择，这对于避免螺钉螺纹与骨界面处出现问题以及潜在的螺钉拔出和继发移位至关重要。本章末尾给出了结论性规则。
