Ermutlu Cenk, Göksel Ferdi, Eken Gökay
Orthopaedics, Bursa Uludag University School of Medicine, Bursa, TUR.
Orthopaedics and Traumatology, Özel Karadeniz Ereğli Anadolu Hospital, Zonguldak, TUR.
Cureus. 2020 Apr 22;12(4):e7773. doi: 10.7759/cureus.7773.
Introduction Periarticular fractures of the knee in adults are generally treated with internal fixation. The Less Invasive Stabilization System (LISS) plate, developed by Arbeitsgemeinschaft Osteosynthesefragen (AO)/Association for the Study of Internal Fixation (ASIF) in the late 1990s, allows reduction and biological fixation through smaller incisions without violating periosteal blood supply. It offers several advantages for the treatment of complex periarticular fractures of the knee. In this study, we have aimed to report the results of a single series of these fractures. Materials and methods Forty-eight patients with AO type 33 and AO type 41 periarticular knee fractures who were operated between 2009 and 2014 at a single institution were included in this retrospective study. Patient demographics, fracture epidemiology, intraarticular extension, concomitant injuries, American Society of Anesthesiologists (ASA) score, time to union, the average time from admission to surgery, and the mean time from operation to patient discharge were noted. The effect of patient and fracture-related factors on length of hospital stay were evaluated. Results The mean follow-up time was 23.7 (12-48) months. The average time from admission till surgery and from surgery till discharge was 10.2 (1-39) and 9.7 (2-35) days, respectively. The average time for union was 6.8 months. Femur fractures healed in mean 6.6 months whereas tibia fractures took 7.1 months to heal. Time from admission to surgery and postoperative hospital stay was longer in patients with higher ASA scores (p<0.01) and open fractures (p<0.001). Patients' body mass index (BMI) and intraarticular extension of the fracture did not cause an increase in either preoperative or postoperative hospital stay (p>0.05). The presence of concomitant major injuries caused a delay in operation (p<0.05), whereas postoperative hospital stay was not different (p>0.05). Conclusion LISS plating provides good stability through a small incision, permits biological fracture healing, may be used in multifragmentary fractures and has low complication rates. It is a good alternative for the treatment of periarticular fractures of the knee.
引言 成人膝关节周围骨折一般采用内固定治疗。20世纪90年代末，由骨科学研究协会（AO）/内固定研究协会（ASIF）研发的微创稳定系统（LISS）钢板，可通过较小切口实现骨折复位和生物学固定，且不破坏骨膜血供。它为治疗复杂的膝关节周围骨折提供了诸多优势。在本研究中，我们旨在报告一系列此类骨折的治疗结果。
材料与方法 本回顾性研究纳入了2009年至2014年在单一机构接受手术的48例AO 33型和AO 41型膝关节周围骨折患者。记录患者的人口统计学资料、骨折流行病学情况、关节内骨折延伸情况、合并伤、美国麻醉医师协会（ASA）评分、骨折愈合时间、入院至手术的平均时间以及手术至患者出院的平均时间。评估患者和骨折相关因素对住院时间的影响。
结果 平均随访时间为23.7（12 - 48）个月。入院至手术的平均时间和手术至出院的平均时间分别为10.2（1 - 39）天和9.7（2 - 35）天。骨折愈合的平均时间为6.8个月。股骨骨折平均6.6个月愈合，而胫骨骨折需要7.1个月愈合。ASA评分较高（p<0.01）和开放性骨折（p<0.001）的患者入院至手术时间和术后住院时间更长。患者的体重指数（BMI）和骨折的关节内延伸情况在术前或术后住院时间方面均未导致延长（p>0.05）。合并严重损伤会导致手术延迟（p<0.05），但术后住院时间无差异（p>0.05）。
结论 LISS钢板通过小切口提供良好的稳定性，允许骨折生物学愈合，可用于多片段骨折且并发症发生率低。它是治疗膝关节周围骨折的良好选择。
