CAJ | 학술논문

目的探讨一种利用AO微创内固定系统(LISS)钢板的解剖形态设计对股骨远端骨折进行间接复位的手术方法.方法 2002年12月至2006年12月对13例复杂股骨远端骨折患者应用Synthes(R) LISS DF型解剖锁定钢板对股骨远端骨折进行间接复位固定,均为男性；年龄18～58岁,平均37.1岁.均为新鲜骨折.股骨远端骨折按AO分型:C2型9例,C3型4例.首先将LISS钢板按照其特定的形态放置于股骨外髁特定的位置并进行固定:正位X线片上D、F孔螺钉平行于膝关节面,侧位X线片上连线与股骨外髁长轴一致；再将钢板近端置于股骨干外侧、平行于股骨干固定,即利用钢板与锁定螺钉固定的空间形态达到股骨远端骨折间接复位的目的.根据股骨外翻角和Blumensaat线对复位固定后的股骨远端骨折进行测量,评价骨折复位情况.[结果]13例患者术后获平均18个月(13～ 36个月)随访.术后3个月骨折愈合率为61.5％(8/13),术后1年所有患者均获骨折愈合.股骨外翻角平均为81.7°±3.5°,Blumensaat线与股骨干长轴夹角平均为38.7°±6.0°.末次随访时骨折固定均无继发移位,内固定物无失效.采用美国特种外科医院膝关节评分标准评定疗效:评分平均为76分(42～96分)；其中优3例,良6例,中3例,差l例,优良率为69.2％.结论利用Synthes LISS DF型解剖锁定钢板的解剖形态可实现股骨远端骨折的间接复位和固定,此方法能简化手术步骤,对失去影像学复位标志的复杂骨折更为有效.
목적 탐토일충이용AO미창내고정계통(LISS)강판적해부형태설계대고골원단골절진행간접복위적수술방법.방법 2002년12월지2006년12월대13례복잡고골원단골절환자응용Synthes(R) LISS DF형해부쇄정강판대고골원단골절진행간접복위고정,균위남성；년령18～58세,평균37.1세.균위신선골절.고골원단골절안AO분형:C2형9례,C3형4례.수선장LISS강판안조기특정적형태방치우고골외과특정적위치병진행고정:정위X선편상D、F공라정평행우슬관절면,측위X선편상련선여고골외과장축일치；재장강판근단치우고골간외측、평행우고골간고정,즉이용강판여쇄정라정고정적공간형태체도고골원단골절간접복위적목적.근거고골외번각화Blumensaat선대복위고정후적고골원단골절진행측량,평개골절복위정황.[결과]13례환자술후획평균18개월(13～ 36개월)수방.술후3개월골절유합솔위61.5％(8/13),술후1년소유환자균획골절유합.고골외번각평균위81.7°±3.5°,Blumensaat선여고골간장축협각평균위38.7°±6.0°.말차수방시골절고정균무계발이위,내고정물무실효.채용미국특충외과의원슬관절평분표준평정료효:평분평균위76분(42～96분)；기중우3례,량6례,중3례,차l례,우량솔위69.2％.결론 이용Synthes LISS DF형해부쇄정강판적해부형태가실현고골원단골절적간접복위화고정,차방법능간화수술보취,대실거영상학복위표지적복잡골절경위유효.
Objective To introduce a type of anatomical locking plate (Synthes(R) LISS DF) in the less invasive stabilization system (LISS) which can have an effect of indirect reduction and fixation on comminuted fractures of the femur.Methods From December 2002 through December 2006,13 male patients with complicated fresh fracture of the distal femur were treated with Synthes LISS DF.Their ages ranged from 18 through 58 years,with an average of 37.1 years.First,a specially shaped LISS DF was placedat the femoral external condyle to fixate the distal femur.The distal locking screws at the holes D and F of the LISS DF plate were paralleled to the knee joint surface in the anteriorposterior view and the line between the screw holes D and F was kept as long as the axis of the femoral lateral condyle in the lateral view.Next the proximal end of the LISS DF was placed at the lateral femur to fixate the femur shaft after traction to restore the length of the femur.After the fixation like this,the femoral fractures were reduced automatically in a functional reduction.The femoral axis orientation and the Blumensaat line were used for evaluation of the reduc-tion.Results All the patients were followed up for an average of 18 months (from 13 to 36 months).The fracture united in 61.5％ (8/13) of the patients at 3 months postoperation and in all at 12 months postoperation.The average distal femoral axis orientation was 81.7°±3.5° and the average angle between the Blumensaat line and the long axis of the femoral shaft was 38.7° + 6.0°.The last follow-up found no secondarydisplacement of the fracture or no implant failure.By the evaluation system of The Hospital for Special Surgery (HSS),the patients scored 76 on average (from 42 to 96).Three cases were rated as excellent,6 as fine,3 as fair and one as poor,with a good to excellent rate of 69.2％.Conclusions LISS DF can be used as a template to fix and reduce simultaneously the comminuted fractures of the distal femur,especially in cases who have lost the reduction marks on X-ray.In this way,the surgical procedures can be simplified to achieve a functional reduction of the femur in a minimally invasive plate osteosynthesis.