锁定加压钢板原理及临床应用

various anatomical regions. This plating system has been supplemented by preshaped LCP implants that can be used in the case of corrective osteotomies close to joints. Preshaped plates have several advantages: intraoperative shaping is no longer required the plate systems themselves help in achieving anatomical reduction, and aiming blocks help in insertion of the locking head screws. In addition, there is a defined placement for each of the given plates and clear rules on how to use each, which are expected to lead to more standardized procedures.

因LCP无需与每个患者骨精确匹配，解剖型LCP逐渐得到发展并应用于不同骨折区域。预塑形的LCP已能用于近关节截骨矫形治疗。预塑形的钢板有几个优点：术中无需再塑形、钢板本身帮助骨折解剖复位，瞄准器帮助锁定螺钉植入。另外，系统提供每块钢板螺钉的确切放置位置及使用规则，这亦使手术更为标准。

These preshaped LCP systems for various anatomical regions have been introduced into clinical practice in addition to the basic, straight 3.5- / 4.0-mm and 4.5-/ 5.0-mm LCP systems and the T- and L-plates. The 3.5-/ 4.0 mm and the 4.5-/5.0-mm LCP are also available for use as reconstruction plates. One purpose the last is suitable for is internal fixation in the region of the symphysis pubis.

除基本的直的3.5/4.0mm及4.5/5.0mm外，根据不同解剖区域预塑形的T型、L型的LCP系统均已应用于临床。这些3.5/4.0mm及4.5/5.0mmLCP亦可作重建钢板用，此适用于耻骨联合区域内固定。

The following preformed LCP systems are currently available. The PHILOS plate is a system that has already proved its worth in clinical practice for use in the region of the proximal humerus, and it is available in a short version with two different lengths (with 2 and with 8 combination holes). The distal humerus LCP is available for distal fractures of the humerus. In addition to the conventional 3.5-mm T-plate, the 2.4-mm LCP system for the distal radius is an option offering advantages over the larger 3.5-mm system in the case of small epiphyseal fragments. For applications in the hand a number of special plates with combination holes are available, which are subsumed under the LCP compact hand system. An anatomically preformed LCP has been introduced to supplement the LISS system for correction of distal fractures of the femur in the vicinity of the knee,and an analogous system, the LCP proximal tibia system, for proximal fractures of the tibia and fractures of the tibial head. Two alternates are available for osteosynthetic treatment of fractures of the distal tibia: the distal tibia LCP and the pilon LCP. The latter is characterized by a larger number of alternate holes in the region of the distal epiphysis of the tibia, which makes the treatment of depression fractures of the distal tibia easier. The LCP system for treatment of fractures of the lower extremities is also supplemented by the LCP metaphysis plate for distal medial tibia (a 12-hole LCP), the LPC condyle plate (applied, for example for internal fixation of the metatarsals), and the wide, arched LCP, which is available in several lengths and is useful (for example) in the treatment of periprosthetic fractures, or also following knee arthrodesis, because it takes account of the actual retrocurvature of the femur, thus allowing all the screws to be centrally anchored in the bone when the plate is fixed laterally (6). 下述LCP系统当前可用。PHILOS钢板系统已在肱骨近端骨折临床实践中显示价值，该系统有两种不同长度（2孔和8孔）可利用。肱骨远端LCP亦可用于肱骨远端骨折。除普通3.5mmT-型钢板外，对于桡骨远端骨折，2.4mmLCP系统在小的骨骺骨折中较大的3.5mm系统提供更多优点。在手外科中，大量归类于LCP简装手外科系统的有联合孔的特种钢板可使用。解剖型LCP已引入LISS系统以矫正膝关节周围股骨远端骨折，类似胫骨近端LCP系统用于胫骨近端及平台骨折。胫骨远端亦有两种选择：胫骨远端LCP和远端平台LCP，

后者特别之处为胫骨远端骨骺区域有更多螺孔供选择，使得处理胫骨远端塌陷骨折更为容易。专用于下肢骨折的LCP系统有胫骨远端内侧干骺端LCP系统（12孔） 、LCP髁钢板（如用于跖骨内固定的）及不同长度如用于假体周围骨折、膝关节融合的宽的弓形LCP。后者因考虑了股骨的实际反屈使得当钢板置于股骨外侧时所有螺钉都可置于骨骼中央。 Biomechanics – In Vitro Studies 生物力学——体外研究

The biomechanical properties of the LCP were thoroughly studied before the system was introduced into clinical use (27, 29). Nevertheless, in parallel with the first clinical evaluation studies a number of additional studies were conducted, and these confirmed the initial results of biomechanical testing prior to clinical application and reemphasized the advantages of the LCP system over conventional fixation systems for special applications.

LCP的生物力学特性在该系统引入临床前已被彻底研究。然而，与一期临床研究同时，大量其他研究亦在进行。这些研究证实临床应用前的生物力学测试初期结果并再次强调在特殊情况下LCP相对普通固定系统的优点。

In an experimental cadaveric model of a C2 radius fracture, the palmar locking compression T-plate proved to yield better stability than conventional plating systems (13). The LCP was found to be mechanically supe rior to the LC-DCP in terms of both antero-posterior stability and torsion in a cadaveric study on the distal radius conducted by Gardner (5). Additionally, in other experimental work, such as a biomechanical examination of plating systems used for the treatment of distal humerus fractures, the LCP system proved to be reliable in achieving primary stable fracture fixation (11). In the proximal humerus, the elasticity of the LCP-PH even seems to lead to load reduction in terms of reduced peak stress at the bone-implant interface, which results in a significantly lower rate of early loosening in weak bone than when rigid implants that provide higher initial stiffness are used (14). In another in vitro experimental study in an equine long bone fracture model, LCP constructs showed the best performance because they had the highest yield strength above which irreversible deformation occurred in this study the LCP system was compared against a clamp-rod internal fixator and the LC-DCP (2).Although these studies provide consistent evidence for the biomechanical superiority of the LCP, it must be mentioned that there have been other well-designed studies that have not revealed any biomechanical advatage of the LCP system over conventional plating systems, such as that performed by Trease’s group, who compared locked and nonlocked palmar and dorsal osteosynthesis of the distal radius (28). Nevertheless, not a single study has revealed any biomechanical disadvantage of the LCP system against conventional plating systems.

在C2型桡骨骨折尸体模型实验中，T型掌侧锁定加压钢板证实较普通钢板系统更稳定。在桡骨远端尸体研究中，就前后稳定性及扭转稳定性而言，在力学上，Gardner发现LCP系统优于LC-DCP。此外，在其他实验研究中，如用于肱骨远端骨折的钢板系统生物力学实验，LCP系统证明获得可靠的一期骨折稳定固定。在肱骨近端中，就骨-内植物界面峰值应力减少而言，LCP-PH的弹性甚至致使载荷降低，这在骨质较差骨固定中，较提供更大初期刚度的坚固内植物明显降低内植物松动率。在另一马的长骨体外实验研究中，与夹棒内支架及LC-DCP比较，LCP结构体在不可逆形变发生前有着最高屈服强度。尽管这些研究一致论证了LCP优越的生物力学特性，但值得一提的是，亦有设计良好的研究并未揭示LCP系统较普通钢板系统更佳的生物力学优势，如Trease’s团体比较的锁定与非锁定固定桡骨远端掌侧、背侧的研究。然而，并无研究发现LCP系统较普通钢板系统生物力学劣势。 CLINICAL RESULTS

临床结果

Since the introduction of the LCP in 2001, various papers have dealt with clinical results obtained with this osteosynthesis system. Overall, satisfactory results have been reported for all published studies. The first clinical study, involving 169 patients treated with LCP, was published by Sommer in 2003, and the authors came to the conclusion that the new system could be regarded as technically mature, since the majority of the patients reported good to excellent clinical outcomes. The numerous options it offers for fixation had made it especially valuable in complex fracture situations and in revision operations after other implants had failed (25). One of the commonest fracture localizations in which the LCP system is used is the distal radius. In contrast to the earlier assumption that open reduction and internal fixation by a dorsal approach is the best policy in cases of dorsally displaced fractures of the distal radius, it has been found that palmar locking plates are safe and effective implants for use in the treatment of dorsally displaced fractures of the distal radius, avoiding any damage to the dorsal extensor s (22). When 2.4-mm LC plates were used good or very good results were obtained even in over 80% of distal radial fractures in osteoporotic bone. Nevertheless, relative to other treatments, intervention with LC plates involves much higher real costs(21). This cost factor is offset by the great advantage of the palmar fixed-angle plate system, which is that the early active movement throughout the range can be facilitated without compromising fracture reduction (15). Good results were also reported by Imatani following the treatment of metaphyseal radius fractures (9).

自2001年LCP介绍以来，大量文章谈及应用该系统所得临床结果。总的来说，所有已版的研究都报告了满意的临床结果。第一个有169位患者使用LCP的临床研究于2003年由Sommer出版，作者得出如此结论：新的固定系统技术上是成熟的，因为大多患者报告了好的或极好的临床结果。系统为固定提供的多种选择使其在复杂骨折及骨折翻修时显示特殊优越性。LCP系统应用的最常见骨折位置之一为桡骨远端骨折。与早期认为桡骨远端背侧移位骨折应采用背侧切开复位内固定治疗假设相反，人们发现，采用掌侧锁定钢板处理此类骨折是安全有效的，同时避免了对背侧伸肌腱损伤。使用2.4mmLCP时，甚至总体80%桡骨远端骨质疏松性患者都获得好或非常好结果。然而，相对其他治疗而言，LCP的介入确实增加了费用。而掌侧成角稳定的钢板系统优势抵消了这一代价，因它允许早期全范围主动活动而不损害骨折复位。Imatani亦报告了桡骨干骺端骨折治疗后好的临床结果。

In further studies LC plates have been successfully used for the treatment of transverse fractures of the sacrum or sternum (23), of periprosthetic fractures (3), and also of fractures and osteoporotic nonunions of the distal humerus (11, 12, 19).stal humerus (11, 12, 19).

进一步的临床研究中，LCP已被成功用于治疗骶骨或胸骨骨折、假体周围骨折及肱骨远端骨折或骨质疏松性骨不连。

The good clinical results published so far should not blind us to the fact that complications can still arise even when LCP are used. In the studies hitherto available, the complications have not been attributable to implant failure so often as to nonobservation of the principles of bridging osteosynthesis. These complications make it plain that both a good knowledge of biomechanics and precise preoperative planning are essential if the use of LCP systems is to be successful (24). 已报告的好的临床结果不应使我们忽视，即使应用LCP，并发症仍可发生。目前可利用的研究表明，并发症并非归因于内植物失败，而常常因违反桥接固定原则。这些并发症清晰表明，若想成功使用LCP系统，应有好的生物力学知识及精确的术前计划。

A particular feature of the application of LC plates that impressed the patients in our population is a tendency to delayed fracture consolidation. Especially in cases in which too little account is

taken of the principle of biological, i.e., bridging, osteosynthesis, the stability of the LCP system might lead to delayed fracture healing, as we observed in some cases of forearm fracture, for example. Analogous observations have been reported following open wedge osteotomies of the proximal tibia (26). Nevertheless, the percentage of cases with delayed union and/or delayed fracture healing seems to be low.

使用LCP给我们周围的患者印象特点是有骨折延迟愈合倾向。尤其在那些很少被考虑生物学如桥接固定原则的患者中，LCP系统的稳定性可导致骨折延迟愈合，这正与我们在一些前臂骨折所观察到的一样。类似的结果出现在胫骨近端开放截骨术后。然而，延迟愈合和/或延迟骨折愈合比例似乎较低。 CONCLUSION 结论

The development of the LCP, which has been available for clinical use since 2001, has revolutionized internal plate fixation insofar as this system combines two different principles of internal fixation, each of which has advantages in specific situations. Thus, a single implant gives the surgeon access to the entire range of options for internal fixation, from compression screw osteosynthesis with the principle of absolute stability to?biological,― i.e., bridging, osteosynthesis with relative stability. These combination options do, however, mean that accurate knowledge of the characteristics of the various principles of internal fixation is essential. The anatomically preshaped plates make it easier for the surgeon to select from the different combinations possible by prescribing the typical type of internal fixation for each segment of the skeletal system. This is intended to help surgeons to reduce the incidence of complications such as were observed in the early years of application of the LCP as a result of nonobservation of the principles of osteosynthesis and to exploit all the options offered by the LCP system. Nonetheless, against the backdrop of the preclinical and clinical data available at present, we can conclude that the LCP system is a reliable and safe tool that extends the options open for internal fixation by plating and has advantages over other systems in terms of the stability that can be achieved with it especially in osteopenic or osteoporotic bone(17).

自2001年临床应用以来，LCP的发展革新了钢板内固定。该系统联合两种不同的内固定原则，而每种原则在在特定情况下尤其优势。因此，一个简单的内植物给术者全面选择，有遵循绝对稳定原则的加压螺钉固定，亦有相对稳定的生物固定如桥接固定。然而，这些联合选择立确意味着必须对不同内固定原则准确理解。解剖型LCP让术者根据每骨折块特征选择不同组合更为容易。这有助于术者减少如以前我们看到的因违反LCP固定原则所致并发症的发生率，亦有助于术者充分利用LCP系统提供的所有功能。然而，根据目前临床前期及临床期资料，我们可下此结论，LCP系统拓展了钢板内固定的选择，是一种安全可靠的工具；就其稳定性而言，尤其在骨质差或骨折疏松情况下，它较其他系统有更大优势。