Boldin Christian, Fankhauser Florian, Hofer Herwig Peter, Szyszkowitz Rudolf
Department of Trauma Surgery, Medical University, Graz, Austria.
Clin Orthop Relat Res. 2006 Apr;445:222-9. doi: 10.1097/01.blo.0000203467.58431.a0.
Proximal tibia fractures present a difficult treatment challenge with historically high complication rates. In a prospective study, we asked whether the Less Invasive Stabilization System (LISS) plate can adequately treat extraarticular and complex intraarticular proximal tibia fractures and provide low complication rates and acceptable long-term functional outcomes. We prospectively observed 25 patients with 26 proximal tibia fractures (AO type A2, A3, C1, C2, or C3) treated with the LISS. Consecutive 3-year followup included radiographs and clinical examinations using Knee Society scores and Hospital for Special Surgery scores for extraarticular and intraarticular fractures. No loss of reduction occurred in patients with extraarticular fractures, whereas varus malalignment occurred in one patient with an intraarticular fracture. Two patients with AO 41 C 3.3 fractures had severe knee arthrosis develop and had total knee replacements. The mean Knee Society scores and final average Hospital for Special Surgery scores were similar for extraarticular and intraarticular fractures. Complications related to the surgery included one delayed union and implant removal in two patients. The LISS provided stable fixation of extraarticular and intraarticular proximal tibia fractures and good functional outcomes with a low complication rate. In complex articular fractures additional screws should be used.
Therapeutic study, Level II (lesser quality randomized controlled trial [eg, < 80% followup, no blinding, or improper randomization]).
胫骨近端骨折治疗难度大，历史上并发症发生率高。在一项前瞻性研究中，我们探讨了微创稳定系统（LISS）钢板能否充分治疗胫骨近端关节外及复杂关节内骨折，并提供低并发症发生率和可接受的长期功能结果。我们前瞻性观察了25例患有26处胫骨近端骨折（AO分型A2、A3、C1、C2或C3）的患者，这些患者接受了LISS治疗。连续3年的随访包括影像学检查以及使用膝关节协会评分和特种外科医院评分对关节外和关节内骨折进行临床检查。关节外骨折患者未发生复位丢失，而1例关节内骨折患者出现内翻畸形。2例AO 41 C 3.3骨折患者发生严重膝关节骨关节炎并接受了全膝关节置换术。关节外和关节内骨折的平均膝关节协会评分及最终平均特种外科医院评分相似。与手术相关的并发症包括1例延迟愈合和2例患者的内固定取出。LISS能为胫骨近端关节外和关节内骨折提供稳定固定，并发症发生率低，功能结果良好。对于复杂关节内骨折，应使用额外的螺钉。
治疗性研究，II级（质量较低的随机对照试验[如随访率<80%、未设盲或随机化不当]）
