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.

目的探讨带锁髓内针治疗胫骨下1/4骨折的方法及存在的问题。方法分析2007年1月—2008年6月我院收治的胫骨下1/4骨折,采用带锁髓内针治疗并且随访时间≥4个月的37例患者临床资料。结果36骨折获得骨性愈合。平均愈合时间16.2周(10~46周)。1例经二次手术后愈合。1例向内侧成角在5~10,°1例向后侧成角在5~10°。34例获得优良的结果。结论带锁髓内针治疗胫骨下1/4骨折要求完善的术前准备,避免胫骨闭合复位可能产生的成角畸形。可以获得满意的治疗效果。

OBJECTIVES:To investigate the safe distance from the tip of the cannulated screw to the apex of the femoral head, and to avoid cutting out of the cannulated screws from the femoral head.METHODS:From November 2007 to April 2008, the placement configuration of the cannulated screws in the femoral head on the anteroposterior (AP) and lateral view was investigated. And the relation between the three-dimensional configuration and the two-dimensional perpendicular view of the femoral head to establish a solid geometry formula was analyzed. According to the configuration, the distances from the tips of different cannulated screws to the apex of the femoral head to confirm the screws placement within the femoral head was measured.RESULTS:The actual risk of cutting out of the cannulated screws varied according to the different placement of the cannulated screws in the femoral head, even if the screw tips were within the femoral head on the AP and lateral radiograph. The mean diameter of femoral head was 49.8 mm. If the cannulated screw is in the center of femoral head on the lateral view, the cannulated screw would not cut out as long as it was in the femoral head on the AP view. When the angle was 22.5°on the lateral view, and under 22.5°on the AP view, the distance from the screw tip to the apex of the femoral head would exceeded 2.2 mm. If the angle > 45°on the AP view, the distance would exceed 9.6 mm. When the angle was 45°on the lateral view, and under 22.5°on the AP view, the distance would exceed 8.2 mm. When the angle > 45°on the AP view, the distance would exceed 17.7 mm. When the angle was 67.5°on the lateral view, the distance would exceed 23.1 mm on AP view.CONCLUSIONS:If the cannulated screw is in the center of femoral head on the lateral view, the cannulated screw won't cut out as long as it is in the femoral head on the AP view. The angle is larger on the AP and lateral view (especially on the lateral view), and the distance is longer.

闭合复位顺行带锁髓内针目前是治疗成人股骨干骨折首选的方法.其优点是愈合率高,畸形愈合和感染率低;缺点是对于股骨干合并同侧髋部骨折的应用有一定限制,髋部的异位骨化发生率高,有会阴神经损伤的风险,需要牵引床等.逆行髓内针是一项相对新的技术,它通过膝关节插入髓内针可以避免以上缺点,过去的临床报道得到的优良结果是一种有吸引力的方法,逐渐得到广泛的应用.我院从1998年1月-2004年6月用逆行髓内针治疗新鲜股骨骨折119例,现总结经验报告如下.