【专题文献】之人工髋关节置换——下肢假体周围骨折的处理

A further development of locking plate osteosynthesis is the concept of Less Invasive Stabilization System (LISS system). This is a pre-shaped plate applied to the extra-medullary surface using locking screws. It combines a locking device conferring good angular stability with a minimally invasive approach to the fracture. The plate can be inserted antegrade or retrograde (Figure 2). This minimal approach results in less periosteal stripping and less disruption to the soft tissues, leading to more favourable biology for bone healing and union. Kobbe et al. reported good mid-term functional results of the use of the LISS system in the treatment of periprosthetic fracture.3 The LISS is most commonly used for more distal diaphyseal fractures and it widely used for supracondylar fractures above a knee arthroplasty as will be discussed later.

关于锁定钢板骨接合术的更进一步的进展是LISS系统（微创钢板稳定系统）。这是一种术前依据髓外骨表面塑形的钢板，使用锁定螺钉。对于骨折它结合了锁定装置的角度固定稳定性和最小的创伤入路（图2

）。这个最小入路导致更小的骨膜剥离和对软组织的更小干扰，对于骨折愈合有更好的生物学优势。Kobbe等报道使用LISS系统治疗假体周围骨折有好的中期功能结果。LISS系统对于更远端骨干骨折是最常用的方法，它广泛用于随后要讨论的膝关节置换术后的股骨髁上骨折。

图2

Combining screw fixation with cerclage wires with a locking system remains controversial. The combination is said to give better fixation of the plate and hence give a more stable construct, but critics suggest that the good hold provided by the locking system renders the use of cerclage wires unnecessary and they also regard them as dangerous as they can act as stress risers.

For conventional plate fixation onto bone the consensus is that screws, cerclage wires or bands have proven to be inefficient when used on their own. A combination has been shown to give good results. Tsiridis et al. showed good results using the Dall-Miles plate, essentially a