胫骨干骨折髓内针固定术后膝关节疼痛的临床观察及原因分析  

Analysis of causes of postoperative anterior knee pain after intramedullary nailing freatment for tibial shaft fractures

作　　者：邹海波[1] 绳厚福[1] 刘朝晖[1] 

机构地区：[1]北京中日友好医院骨科,北京100029

出　　处：《中国矫形外科杂志》2008年第10期731-733,共3页Orthopedic Journal of China

摘　　要：[目的]通过对256例胫骨干骨折髓内针固定后病人膝关节前侧疼痛的临床观察,分析膝关节前侧疼痛的原因。[方法]回顾性分析本院自2000年1月～2007年12月应用髓内针治疗的胫骨干骨折的病人共256例。其中男183例,女73例。平均45岁,其中76例(30%)的病人是开放性骨折,156例(60%)病人在伤后24h之内进行手术,其余100例(40%)病人在伤后12d内予以手术治疗。[结果]共有166例病人发生了膝关节前侧的疼痛,占病人总数的65%。其中经髌韧带入路者96例(发生率为58%);髌韧带旁入路者为70例(发生率为42%)。膝关节前侧疼痛在活动后加重。在166例病人中,有90例(54%)病人在术后1年髓内针取出后疼痛感消失,经休息或口服止痛药物缓解的为33例(20%),其余病人在加强膝关节周围肌肉的练习后疼痛感减轻或消失。[结论]手术入路的不同并不能减少胫骨干骨折髓内针治疗后膝关节前侧疼痛的发生,而髓内针的移除、加强膝关节周围肌肉的练习可减少此种疼痛的发生。[ Objective ] To analyze the causes of anterior knee pain after intramedullary（ IM ） nailing treatment of tibial shaft fractures. [ Method] A total of 256 patients with tibial shaft fractures were treated with intramedullary nailing from 2000 to 2007 in our hospital. There were 183 males and 73 females with a mean age of 45 years. All patients were followed up at least once after fracture healing. [ Result] Among 256 patients, 166 experienced anterior knee pain, accounting for 65%. Ninety-six （ 58% ） treated with transtendinous nailing complained of and 70 （42%） treated with paratendinous nailing complained of anterior knee pain. It was worsened after activity but relieved only in 33 （20%） by resting or taking analgesic drugs. The anterior knee pain disappeared one year after the IM nailing was taken out. [ Conclusion] Anterior knee pain can not be reduced by different approaches of operation for tibial shaft fractures. However, the removal of intramedullary nailing and the muscle exercises around the knee joint can reduce the occurrence of anterior knee pain.

关 键 词：胫骨干骨折 髓内针 膝关节前侧疼痛 

分 类 号：R687.3[医药卫生—骨科学]