Orthopaedic Surgery and Traumatology Department, Hautepierre Hospital, Strasbourg University Hospitals, 1, avenue Molière, 67098 Strasbourg cedex, France.
Orthop Traumatol Surg Res. 2011 Oct;97(6):668-74. doi: 10.1016/j.otsr.2011.05.004. Epub 2011 Sep 15.
Minimally-invasive fixation using a locking plate and early motion is normal practice. However, technical errors and pitfalls are common. This surgery has a set of rules that encompass both the mechanics of the internal fixation system and the implantation itself. If these rules are not strictly followed, alignment defects and/or early failure of the fixation can occur. We analysed four cases of clinical failure that were encountered after minimally-invasive distal femoral extra-articular fixation with locking plates. The following rules must be followed with this technique: extra-articular fracture, minimally-invasive approach, long plate alternating between locking screw and empty hole (five holes on either side of fracture), bi-cortical screws, placement of locking screws near a complex fracture but away from a simple fracture. Osteoporotic bone, obesity that interferes with the instrumentation, articular fracture, horizontal fracture line and surgeon experience are all limitations of this minimally-invasive technique.
微创使用锁定板固定并早期活动是常规做法。然而，技术错误和陷阱很常见。这种手术有一套规则，包括内固定系统的力学和植入物本身。如果不严格遵守这些规则，可能会出现对线不良和/或固定早期失败。我们分析了 4 例微创关节外股骨远端锁定板固定后临床失败的病例。以下规则必须遵循该技术：关节外骨折、微创入路、长钢板交替使用锁定螺钉和空孔（骨折两侧各 5 个孔）、双皮质螺钉、将锁定螺钉放置在复杂骨折附近但远离简单骨折处。骨质疏松性骨、影响器械操作的肥胖、关节骨折、水平骨折线和外科医生经验都是这种微创技术的局限性。
