Department of Traumatology, University Hospital Leuven, Herestraat 49, 3000 Leuven, Belgium.
Injury. 2009 Apr;40(4):449-54. doi: 10.1016/j.injury.2008.09.007. Epub 2009 Mar 13.
To evaluate the Less Invasive Stabilisation System (LISS) in the treatment of segmental tibial fractures.
A prospective series of 23 consecutive open acute segmental tibial fractures were treated with a long LISS plate, in a university hospital. All but three fractures were temporarily fixed with a unilateral external frame. The minimal follow-up was 2 years.
Mean age of the casualties was 34 (17-72) years, all but two were male and all were involved in high-energy accidents, had multiple injuries and open fractures. Of the fractures, 4 were grade IIIA, 16 grade IIIB and 3 grade IIIC. It was possible to span the distal fracture with the LISS plate in 20 cases; of these, 3 developed compartment syndrome. Two people with trifocal fractures required additional distal plates, one of which became loose and infected, resulting in a malunion of 8 degrees. Dermatofasciotomy was performed in 13 cases, in 10 of these as a preventive measure and in 3 because of impending compartment syndrome. In five cases a post-fixation neural palsy of the extensor hallucis longus was observed. All except three fractures healed; mean time for union for the proximal fractures was 16 (10-24) weeks and for the distal fractures was 22 (16-44) weeks.
Use of the LISS plate in fixing these difficult fractures is commended, but immediate fixation should be avoided. A staged sequential procedure with a temporary spanning external fixation and definitive treatment after soft-tissue healing is preferred.
评估微创稳定系统（LISS）治疗胫骨节段性骨折的效果。
在一家大学医院，对 23 例连续开放性急性胫骨节段性骨折患者采用长 LISS 板进行前瞻性治疗。除 3 例外，所有骨折均采用单侧外固定架临时固定。最小随访时间为 2 年。
患者平均年龄为 34 岁（17-72 岁），除 2 例外均为男性，均因高能事故受伤，合并多发伤和开放性骨折。骨折中，4 例为 3A 型，16 例为 3B 型，3 例为 3C 型。20 例可采用 LISS 板跨越远端骨折，其中 3 例发生骨筋膜室综合征。2 例三焦点骨折需附加远端钢板，其中 1 例钢板松动感染，导致 8 度畸形愈合。13 例施行皮肤切开减压术，其中 10 例预防性施行，3 例因即将发生骨筋膜室综合征施行。5 例出现伸趾长肌术后神经麻痹。除 3 例外，所有骨折均愈合；近端骨折愈合时间为 16 周（10-24 周），远端骨折愈合时间为 22 周（16-44 周）。
推荐使用 LISS 板固定这些困难骨折，但应避免即刻固定。我们倾向于采用分期序贯方法，先用临时跨接外固定架，待软组织愈合后再进行确定性治疗。
