Rosenkranz Jan, Babst Reto
Chirurgische Klinik A, Kantonsspital Luzern, Schweiz.
Oper Orthop Traumatol. 2006 Mar;18(1):88-99. doi: 10.1007/s00064-006-1164-4.
Facilitation of reduction and retention in LISS (Less Invasive Stabilizing System) plate osteosynthesis of fractures of the distal femur by application of the large AO distractor.
Any distal femoral fracture suited to LISS plate osteosynthesis.
Distraction can lead to a pullout of the Schanz screws in patients with pronounced osteoporosis.
Supine. Normal LISS osteosynthesis with lateral or parapatellar approaches. Insertion of one Schanz screw proximal to the end of the plate through a stab incision. Introduction of the LISS plate in the usual fashion and insertion of a second Schanz screw into plate hole "A", parallel to the joint. Assembly of the distractor onto the Schanz screws, distraction of the femur to the correct length and correction of varus/valgus alignment with the aid of the cable method, as well as correction of ante- and retrocurvature by insertion of an additional Schanz screw at the anterior aspect. At least two locking head screws should be inserted into the plate holes both proximally and distally. Removal of the AO distractor. Assembly of aiming guide and insertion of further screws into additional plate holes using the guide sleeve.
Between May 1998 and September 2001, a total of 42 patients had their distal femoral fractures stabilized by LISS. The AO distractor was used from the 18th case onward. A time saving of approximately 13% was estimated, taking the learning curve of the LISS system into consideration. Three of 42 fractures showed relevant postoperative varus or valgus malalignment. No rotational malalignment was found. An effect of the LISS tractor on the incidence of malalignment could not be found with the limited number of cases examined; however, malalignment was correlated well with the rates found in literature for distal femoral fractures.
应用大型AO撑开器促进股骨远端骨折的微创稳定系统（LISS）钢板接骨术中骨折的复位与固定。
任何适合LISS钢板接骨术的股骨远端骨折。
对于骨质疏松明显的患者，撑开可能导致斯氏针拔出。
仰卧位。采用外侧或髌旁入路进行常规LISS接骨术。通过一个小切口在钢板末端近端插入一枚斯氏针。以常规方式置入LISS钢板，并在钢板孔“A”中平行于关节插入第二枚斯氏针。将撑开器安装在斯氏针上，将股骨撑开至正确长度，并借助缆线法矫正内翻/外翻对线，以及通过在前方插入额外的斯氏针矫正前凸和后凸。应至少在钢板孔的近端和远端各插入两枚锁定头螺钉。移除AO撑开器。安装瞄准导向器，并使用导向套筒在其他钢板孔中插入更多螺钉。
在1998年5月至2001年9月期间，共有42例患者的股骨远端骨折通过LISS固定。从第18例开始使用AO撑开器。考虑到LISS系统的学习曲线，估计节省了约13%的时间。42例骨折中有3例术后出现明显的内翻或外翻畸形。未发现旋转畸形。在所检查的有限病例数中，未发现LISS撑开器对畸形发生率有影响；然而，畸形发生率与文献中报道的股骨远端骨折发生率相关性良好。
