Cole Peter A, Zlowodzki Michael, Kregor Philip J
Department of Orthopedic Surgery, University of Minnesota, Regions Hospital, St. Paul, MN, USA.
J Orthop Trauma. 2004 Sep;18(8):528-35. doi: 10.1097/00005131-200409000-00008.
To summarize the surgical experience and clinical results of the first 89 fractures of the proximal tibia treated with the Less Invasive Stabilization System (LISS; Synthes, Paoli, PA).
Retrospective analysis of prospectively enrolled patients into a database.
Academic level I trauma center.
SUBJECTS/PARTICIPANTS: Eighty-seven consecutive patients with 89 proximal tibia fractures (AO/OTA type 41 and proximal type 42 fractures) treated by 2 surgeons. Seventy-five patients with 77 fractures were followed until union. The mean follow-up was 14 months (range: 3-35 months). There were 55 closed fractures and 22 open fractures.
Surgical reduction and fixation of fractures, followed by rehabilitation.
Perioperative and postoperative complications, postoperative alignment, loss of fixation, time to full weight bearing, radiographic union, and range of motion.
Seventy of 77 fractures healed without major complications (91%). There were 2 early losses of proximal fixation, 2 nonunions, 2 deep delayed infections, and 1 deep peroneal nerve palsy. Other complications included a superficial wound infection and 3 seromas. Postoperative malalignment occurred in 7 patients with 6 degrees to 10 degrees of angular deformity (6 flexion/extension and 1 varus/valgus malalignments), and an eighth patient had a 15 degrees flexion deformity. In 4 patients, the hardware was removed at an average of 13 months because of irritation (5%). The mean time for allowance of full weight bearing was 12.6 weeks (range: 6-21 weeks), and the mean range of final knee motion was 1 degrees to 122 degrees .
The LISS provides stable fixation (97%), a high rate of union (97%), and a low (4%) rate of infection for proximal tibial fractures. The technique requires the successful use of new and unfamiliar surgical principles to effect an accurate reduction and acceptable rate of malalignment.
总结采用微创稳定系统（LISS；辛迪斯公司，宾夕法尼亚州波利）治疗的89例胫骨近端骨折的手术经验及临床结果。
对前瞻性纳入数据库的患者进行回顾性分析。
一级学术创伤中心。
受试者/参与者：87例连续患者共89处胫骨近端骨折（AO/OTA 41型和近端42型骨折），由2名外科医生治疗。75例患者共77处骨折获得随访直至骨折愈合。平均随访时间为14个月（范围：3 - 35个月）。其中闭合性骨折55例，开放性骨折22例。
手术复位并固定骨折，随后进行康复治疗。
围手术期及术后并发症、术后对线情况、内固定失效情况、完全负重时间、影像学愈合情况及活动范围。
77处骨折中有70处愈合，无重大并发症（91%）。发生2例早期近端内固定失效、2例骨不连、2例深部迟发性感染及1例腓总神经深部麻痹。其他并发症包括1例浅表伤口感染和3例血清肿。7例患者术后出现对线不良，成角畸形6°至10°（6例屈伸畸形和1例内外翻畸形），第8例患者出现15°屈曲畸形。4例患者因内固定刺激平均在13个月时取出内固定（5%）。完全负重的平均时间为12.6周（范围：6 - 21周），最终膝关节活动的平均范围为1°至122°。
LISS为胫骨近端骨折提供了稳定的固定（97%）、较高的愈合率（97%）和较低的感染率（4%）。该技术需要成功运用新的且不熟悉的手术原则以实现准确复位及可接受的对线不良发生率。
