胫骨干骨折髓内钉治疗术后膝关节痛的临床观察

目的通过对胫骨干骨折髓内钉内固定治疗后膝关节痛的临床观察,探讨膝关节痛的发生和病因。方法回顾研究1996年5月～2006年4月应用交锁髓内钉内固定治疗胫骨干骨折685例,所有病例在骨折愈合后均有1次以上的随访,平均随访时间为24.2个月。结果共有165例术后发生膝关节痛,经髌韧带入路组膝关节痛发生率为34.5%,髌韧带内侧入路组为14.6%,两组有显著性差异。结论髌韧带旁入路能减少胫骨干骨折髓内钉治疗术后膝关节痛的发生,建议使用髌韧带周围入路,髓内钉固定后膝关节痛的原因尚需进一步研究。

A Clinical Study on Postoperative Knee Pain Following Treatment of Tibial Shaft Fracture by Intramedullary Nailing

Objective To study the incidence and etiology of anterior knee pain in patients with tibial shaft fracture after intramedullary nailing treatment.Methods From May 1996 to Apr 2006,685 patients with tibial shaft fracture were treated with intramedullary nailing in our hospital.Their clinical data were retrospectively studied.All the patients were followed up at least once after fracture healing and the average clinical follow-up duration was 24.2 months.Results The 165 patients experienced knee pain,34.5 percent of the patients treated with transtendinous nailing reported anterior knee pain,and 14.6 percent of the patients treated with paratendinous nailing reported anterior knee pain.A significant intergroup difference was seen in statistics.Conclusion Compared with the transpatellar tendon approach,the paratendinous approach for nail insertion can reduce the incidence of anterior knee pain.The parapatella tendous approach is recommended and a further study on the postoperative knee pain for tibial intramedullary nailing is needed.