应用经髌上入路交锁髓内钉技术治疗胫骨骨折

目的：探讨应用经髌上入路交锁髓内钉技术治疗胫骨骨折的短期疗效。方法：2016年1月至2018年6月采用交锁髓内钉手术治疗80例胫骨骨折患者，根据手术入路不同分为观察组（经髌上入路）和对照组（经髌韧带入路）。其中观察组40例，男28例，女12例，年龄28~67（46.70±10.34）岁；对照组40例，男30例，女10例，年龄31~69（49.38±10.74）岁。记录并比较分析两组患者手术时间，切口长度，术中X线机透视次数，术中失血量，骨折愈合时间，术后主动直腿抬高（straight leg raise，SLR）时间，住院时间，膝痛视觉模拟评分（visual analogue scale，VAS），膝关节疼痛率，术后美国特种外科医院（Hospital for Special Surgery，HSS）膝关节评分等指标。结果：全部病例获得随访，时间19~38（24.60±4.52）个月。观察组手术时间（53.83±7.01） min，切口长度（3.98±0.83） cm，术中X线机透视次数（18.90±1.75）次，骨折愈合时间（10.03±0.89）周，术后SLR时间（1.19±0.25） d，住院时间（6.73±1.06） d均优于对照组（P<0.05）。末次随访，根据HSS评分评估疗效，观察组优34例，良5例，可1例，差0例；对照组优25例，良9例，可6例，差0例；观察组疗效优于对照组（P<0.05）。结论：采用经髌上入路交锁髓内钉内固定治疗胫骨骨折，具有创伤小、膝关节功能恢复更好等优点，可获得更加满意的临床效果，可进一步广泛应用。

A follow up study on the treatment of tibial fractures with intramedullary interlocking nail through the suprapatellar approach

Objective: To investigate the short-term effect of suprapatellar interlocking intramedullary nail in the treatment of tibial fractures.Methods: Eighty patients with tibial fractures treated from January 2016 to June 2018 were treated with interlocking intramedullary nail,who were divided into observation group (suprapatellar approach) and control group (patellar ligament approach) according to different surgical approaches. There were 40 cases in the observation group,including 28 males and 12 females,aged 28 to 67 years with a mean of(46.70±10.34) years. There were 40 cases in the control group,including 30 males and 10 females,aged 31 to 69 years with a mean of(49.38±10.74) years. The operation time,incision length,intraoperative C-arm X-ray fluoroscopy times,intraoperative blood loss,fracture healing time,postoperative active straight leg raise(SLR) time,hospital stay,visual analogue scale(VAS),knee pain rate and postoperative Hospital for Special Surgery(HSS) score were recorded and compared between two groups.Results: All the patients were followed up,and the duration ranged from 19 to 38 months,with an average of(24.60±4.52) months. In the observation group,the operation time was(53.83±7.01) min;the incision length was(3.98±0.83) cm;the number of intraoperative C-arm X-ray fluoroscopy was(18.90±1.75) times;the fracture healing time was(10.03±0.89) weeks;the postoperative active SLR time was (1.19±0.25) days;and the hospital stay was(6.73±1.06) days. The above indexes were better than those in the control group (P<0.05). In the latest follow-up,34 cases got an excellent result,5 good,1 fair and 0 poor in the observation group. In the control group,25 cases got an excellent result,9 good,6 fair and 0 poor. The curative effect of the observation group was better than that of the control group(P<0.05).Conclusion: The treatment of tibial fractures with suprapatellar interlocking intramedullary nail has the advantages of less trauma and better recovery of knee function. It can obtain more satisfactory clinical results and can be further widely used.