2种入路髓内钉治疗胫骨干骨折的对比研究

目的:比较关节外半伸膝位内侧髌旁入路与经髌腱入路髄内钉技术治疗胫骨干骨折的临床疗效。方法:回顾性分析2018年11月-2019年12月,采用关节外半伸膝位内侧髌旁入路髄内钉技术治疗胫骨干骨折13例病例(观察组)的临床资料,并与同时期18例采用传统屈膝位经髌腱入路髄内钉技术治疗的胫骨干骨折病例(对照组)进行对比研究。2组患者在性别、年龄、致伤原因、骨折分型及受伤至手术时间等一般资料的差异均无统计学意义(P>0.05)。记录手术时间、术中出血量、术中透视次数、骨折临床愈合时间、随访期间并发症及髌前疼痛发生情况,采用Lysholm评分评价膝关节功能。结果:观察组手术时间及术中透视次数少于对照组,具有统计学差异(P<0.05);2组术中出血量比较,差异无统计学意义(P>0.05)。2组患者均获得随访,随访时间12-43个月,平均28.4个月。2组患者骨折临床愈合时间比较,差异无统计学意义(P>0.05)。膝前疼痛发生率2组比较,观察组15.4%,低于对照组33.3%,但差异无统计学意义(P>0.05)。末次随访,2组采用VAS评分及Lysholm评分标准评价临床疗效,差异均无统计学意义(P>0.05)。结论:关节外半伸膝位髌旁内侧入路、经髌腱入路髄内钉技术治疗胫骨干骨折均可获得较好疗效。关节外半伸膝位髌旁内侧入路髓内钉技术在髄内钉置钉时可使骨折复位及维持、透视等操作更加简单,在减少手术时间及术中透视次数方面具有优势,值得临床推广。

Comparison of Intramedullary Nailing for the Treatment of Tibial Shaft Fracture via Extra-articular Semiextended Medial Parapatellar Approach and Transpatellar Approach

Objective:To compare the ffectiveness of extra-articular semiextended medial parapatellar approach and transpatellar approach in intramedullary nailing for the treatment of tibial shalft fracture.Methods:Between November 2018 and December 2019,31 patents with closed fracture of the tibial shaft were treated with intramedullary nailing,and the clinical data were retrospectively analyzed.13 patients were treated through the extra-articular semiextended medial parapatellar approach(Group A)and the other 18 patients via a regular transpatellar approach(Group B).There was no significant difference in gender,age,reasons of injury,fracture classification,time from injury to operation,and the duration of follow up between the two groups(P>0.05).The operation time,intraoperative blood loss,fluoroscopy frequency during operation,fracture union time,and complications,condition of anterior knee pain were recorded.The effctiveness was evaluated according to Visual Analog Pain Score(VAS)and Lysholms knee scorein the last follow up.Results:The op-eration time and fluoroscopy frequency during operation ingroups A was signifcantly less than those in group B(P<0.05).There was no.significant diference in blood loss between the two groups(P<0.05).The average time of fllo up was 28.4 months(12-43months).There was no significant difference in fracture union time and the incedence of complications.During the follow up period,group A has a lower mobidity of anterior knee pain than group B(15.4%VS33.4%),but there was no staitically significant difference(P>0.05).There was no significant difference in VAS or Lysholms knee score in the last follow up of the two groups(P<0.05).Conclusion:Intr-amedullary nailing for the treatment of tibial shaft fracture via extra-articular semiextended medial parapatellar approach and transpatellar approach had satisfied result.Extra-articular semiextended medial parapatellar approach of intramedullary nailing was better than transpatellar approach with less operation times or fluoroscopy frequency during operation.We recommend this technique because it simpli-fied intraoperative imaging,fracture reduction,and maintenance of reduction during nail insertion.