胫骨干骨折髓内钉固定术中置钉点的影像学研究及临床应用

目的对胫骨干骨折髓内钉固定术中理想置钉点的进行影像学研究,并探讨其临床疗效。方法 2006年5月至2010年12月,对160例胫骨干骨折通过术前透视确定置钉点的位置,选择性地采用髌韧带内侧入路、髌韧带外侧入路或经髌韧带入路进行切开复位内固定治疗。结果髌韧带宽度为27～43mm,平均34.38±3.69mm。若将髌韧带依宽度划分3等份,42例的理想置钉点位于外侧区域,95例位于中间区域,23例位于内侧区域;若将髌韧带依宽度划分成内外侧2等份,则有90例的理想置钉点位于外侧区域,60例位于内侧区域。本组患者均获随访时间12～85个月,平均39.3个月。根据Johner-Wruhs评分标准,总体优良率为96.3%,术后发生患侧膝关节疼痛共有29例（18.1%）。结论术前通过透视确定置钉点的位置,选择性地采用相应的手术入路,是相当重要的准备工作。个体化的手术入路有利于髓内钉置钉点的显露,膝关节内结构损伤小,疗效可靠,并有效降低膝关节疼痛并发症的发生率。

Radiographic study of the ideal set point for tibial intramedullary nail and its clinical significance

Objective To study the radiographic parameters of the ideal set point for tibial intrmnedullary nail,and discuss its clinical efficacy.Methods From May 2006 to December 2010,160 cases of tibial shaft fractures were treated with tibial intrmnedullary nail,determined the location of the point set screw by the preoperative fluoroscopy,and selectively chosen a medial parapatellar,lateral parapatellar or transpatellar approach for open reduction and internal fixation.Results The average width of tendon was 34.38±3.69mm(range,27～43mm).When divided into three equal zones,the starting point was located in the lateral zone in 42 knees,the middle zone in 95 knees,and the medial zone in 23 knees.When divided into two equal zones,the starting point fell into the lateral zone in 90 knees and the medial zone in 70 knees.The average follow-up was 39.3 months(range,12～85 months).According to Johner-Wruhs Score,the overall excellent or good rate was 96.3%.There were 29 cases of ipsilateral knee pain happened after operation.Conclusion It is essential to determine the location of the point set screw by the preoperative fluoroscopy,and selectively choose a relevant approach before operation.An individualized surgical approach could get enough surgical exposure of the set point for tibial intrmnedullary nail,little structural damage within the knee,better clinical results,and effectively reduction of the incidence of postoperative knee pain.