锁定加压钢板原理及临床应用

SUMMARY摘要The principle of the locking compression plate (LCP) is represented by the combination of two completely different anchorage technologies and two opposed principles of osteosynthesis in one implant it combines the principles of conventional plate osteosynthesis for direct anatomical reduction with those of bridging plate osteosynthesis. Since the LCP can be used as a conventional plate using only dynamic compression, as a pure internal fixator using locking head screws,or as both combined, it provides the surgeon with multiple variations. Nevertheless, these new possibilities mean that preoperative planning and an understanding of the different biomechanical principles of osteosynthesis are essential if good clinical outcomes are to be achieved and maximum benefit is to be attained from the options offered by the LCP system.锁定加压钢板为两种完全不同的固定技术的结合，该内植物包含两种相反的接骨术原理，即以直接解剖复位为特点的传统钢板接骨术和桥接钢板接骨术。

LCP既可仅当作动力加压钢板使用，亦可通过锁定螺钉而进作为内支架使用，或是上两种方式的联合，这为外科医师提供多种选择。

然而，这些新的可能性亦即意味着，若要想获得LCP系统带来的最大价值及好的临床结果，则必须理解不同的生物力学接骨术原理及做好术前准备。

The current article provides biomechanical background to and guidelines for the use of LC plates in the operative treatment of fractures and also reports experimental and clinical results obtained with LCP。

本文既提供骨折手术治疗时LCP使用的生物力学背景及指南，亦报告应用LCP获得的实验及临床结果。

INTRODUCTION引言Since the first instance of internal fixation with a plate(carried out by Hansmann in Hamburg in 1886 (8) and the later integration of this principle into operative fracture treatment as a result of Lambotte’s work, both the implants used and the related principles of fracture treatment have been in a state of continuous development.自第一例应用钢板内固定治疗（1886年，Hansmann在Hamburg实施）及其后Lambotte将这些整理为骨折手术治疗的原则以来，内植物及骨折治疗的相关原则正持续发展。

While in the early years of internal fixation with plates various principles were pursued in parallel, the standardization of the indications for and techniques of internal fixation with compression plates by the Swiss Association for the Study of Internal Fixation (ASIF) was one of the achievements of the 1950s that were later taken further by the Working Group on Matters Concerned with Internal Fixation (AO). The object of the technique of operative treatment of fractures with compression internal fixation described in the first edition of the AO Manual of Internal Fixation was thus stable internal fixation with the purpose of giving the bone primary strength to allow ;early functional mobilization it was intended that this should be achieved by applying the principle of interfragmentary compression with the object of absolute stability. The dynamic compression plate (DCP) was developed to realize this objective of internal fixation, and it allowed axial compression of the fracture zone by way of eccentric drilling for compression screws. In keeping with this principle, such an internal fixation operation led to primary bone-fracture consolidation without visible callus formation. Conventional plating methods are based on the use of an adequate number of anchoring screws to press the plate against the bone with high compressive forces, creating a stable bone-implant connection. When this technique is used, biocortical screws yield the best possible anchoring force. Even tiny fragments were adaptedin the course of this interfragmentary compression, which required wide exposure of the fracture zone. Denudation of the individual fragments and exposure of the fracture zone consequently led to increased rates of infection, nonunion, and delayed healing, owing to lacking bone and soft tissue vitality.早年时期钢板内固定遵循着不同的原则，二十世纪五十年代，瑞士内固定协会标化了加压钢板内固定手术技术及手术适应症，随后这些理论由AO进一步发展。

第一版AO内固定手册描述骨折加压钢板内固定治疗的目的是坚强内固定，以便术后初期骨骼有足够强度来早期活动，而这可通过骨折块间加压达到骨折端绝对稳定得以实现。

动力加压钢板的发展实现了这一内固定目的，它通过偏心钻孔、加压螺钉的放置完成骨折区轴向加压。

与这一原则相映，如此内固定手术可导致无可见骨痂形成的一期骨愈合。

传统钢板固定方法基于采用足够数量螺钉通过高压应力将钢板固定于骨面而产生稳定骨-内植物连接。

应用此技术时，双皮质螺钉固定产生可能的最大把持力。

然而，很小的骨折块采用折块间减压技术时，亦要求广泛的骨折区暴露。

单个骨折块的剥离及骨折区的暴露因骨、软组织活力的丧失而随之导致感染、骨不连和骨折延迟愈合。

During the 1980s, the principle of absolute stability through interfragmentary compression, which is still valid today in the operative treatment of joint fractures,was increasingly reconsidered against the backdrop of the raised complication rates for osteosynthesis with compression plate systems performed to treat diaphyseal fractures. Not the smallest factor in these considerations was that of the outcomes obtained with medullary nailing, a technique that led to satisfactory treatment results by way of secondary bone healing with callus formation though absolute stability was not achieved. Logically, this led to the concept of internal fixation with bridging plates (1, 7) for the treatment of diaphyseal fractures. According to this principle, the fracture zone of fragmented fractures of a shaft or metaphysis remains undisturbed during surgery following realignment taking account of the axis, length, and rotation, and the bridging plate is anchored in the main fragments proximal and distal to the fracture. In contrast to conventional internal fixation, then, this form of internal fixation yields only relative stability and the secondary bone healing with callus formation is thus no longer an undesirable side-effect, but rather the object of treatment. The nonexposure of the fracture zone means that additional devascularization of bone fragments is avoided. In view of this, the term ?biological plate osteosynthesi s― has been introduced for bridging internal fixation (1, 18).二十世纪八十年代，这一今天仍适用于关节内骨折的治疗原则-骨折块间加压坚强内固定，伴随加压钢板系统治疗骨干骨折后并发症发生率的增高被重新斟酌。