Freimoser Florian, Grechenig Stephan, Ofenhitzer Anna, Bakota Bore, Staresinic Mario, Pfeifer Christian G
Department of Trauma and Orthopaedic Surgery, University Medical Centre Regensburg, Germany.
Trauma and Orthopaedic Surgery department, Brighton and Sussex University Hospital, NHS Trust, UK.
Injury. 2017 Nov;48 Suppl 5:S56-S60. doi: 10.1016/S0020-1383(17)30741-6.
The Less Invasive Stabilisation System (LISS) is an angle-stable plate that enables treatment of distal femoral comminuted and periprosthetic fracture. As it is placed through a minimally-invasive lateral approach, lateral knee pain is a commonly described symptom after its application. This study investigates knee lateral collateral ligament (LCL) iatrogenic injury during LISS plate fixation. A cadaver study was performed and a retrospective radiological investigation with the analysis of its clinical application was conducted to evaluate possible knee LCL damage.
The cadaver study included 13 human lower extremities, treated with LISS. After application, lateral knee side was dissected, implants were removed and distances between the drill holes and LCL origin were measured. In the retrospective radiological evaluation, postoperative X-rays for patients treated with distal femoral LISS plate in the University Hospital Regensburg, Germany from January 2010 to December 2015 were examined. Following a protocol described by Pietrini et al., the LCL origin on postoperative X-rays was calculated, both in lateral and anterior-posterior (AP) view, and distances between the plate and its closest locking screw to the LCL origin were measured.
In the cadaver study, the mean distance between the closest drilling hole and the ligament origin was 14.0mm (range 9-21mm; SD 3.8mm). Twenty-two patients matched the inclusion criteria for the retrospective radiological study. In lateral view, the mean distance between the origin and the closest locking screw was 6.3mm (range 0-16.4mm; SD 4.7mm); the mean distance between the origin and the plate was 3.1mm (range 0-13.9mm; SD 4.1mm). In AP view, the mean distance between LCL origin and the nearest screw was 2.4mm (range 0-7.6mm; SD 2.4mm). The mean distance between the origin and the most distal locking screw was 9.2mm (range 0-17.5mm; SD 4.0mm).
The LISS is a safe option to treat distal femoral fractures in respect to the LCL. Due to close proximity, the LCL might be harmed; therefore, lateral knee pain or lateral instability after implantation should be assessed in further treatment.
微创稳定系统（LISS）是一种角度稳定钢板，可用于治疗股骨远端粉碎性骨折和假体周围骨折。由于它是通过微创外侧入路置入的，术后外侧膝关节疼痛是常见的症状。本研究调查了LISS钢板固定过程中对膝关节外侧副韧带（LCL）的医源性损伤。进行了一项尸体研究，并对其临床应用进行了回顾性影像学调查，以评估可能的膝关节LCL损伤。
尸体研究包括13条接受LISS治疗的人下肢。置入后，解剖膝关节外侧，取出植入物，并测量钻孔与LCL起点之间的距离。在回顾性影像学评估中，检查了2010年1月至2015年12月在德国雷根斯堡大学医院接受股骨远端LISS钢板治疗患者的术后X线片。按照Pietrini等人描述的方案，在侧位和前后位（AP）视图中计算术后X线片上的LCL起点，并测量钢板与其最靠近LCL起点的锁定螺钉之间的距离。
在尸体研究中，最靠近的钻孔与韧带起点之间的平均距离为14.0mm（范围9 - 21mm；标准差3.8mm）。22例患者符合回顾性影像学研究的纳入标准。在侧位视图中，起点与最靠近的锁定螺钉之间的平均距离为6.3mm（范围0 - 16.4mm；标准差4.7mm）；起点与钢板之间的平均距离为3.1mm（范围0 - 13.9mm；标准差4.1mm）。在AP视图中，LCL起点与最近螺钉之间的平均距离为2.4mm（范围0 - 7.6mm；标准差2.4mm）。起点与最远端锁定螺钉之间的平均距离为9.2mm（范围0 - 17.5mm；标准差4.0mm）。
就LCL而言，LISS是治疗股骨远端骨折的一种安全选择。由于距离较近，LCL可能会受到损伤；因此，在进一步治疗中应评估植入后外侧膝关节疼痛或外侧不稳定情况。
