髌上入路META—NAIL锁定型胫骨髓内钉在胫骨干骨折中的初步应用  

Meta-nailing for tibial fractures via the supra-patellar approach

作　　者：高伟[1] 吴晓明[1] 高堪达[1] 黄建华[1] 王建东[1] 王秋根[1] 李凡[1] 

机构地区：[1]上海交通大学附属第一人民医院骨科,200080

出　　处：《中华创伤骨科杂志》2013年第7期559-562,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨髌上入路META—NAIL锁定型胫骨髓内钉治疗特殊类型胫骨干骨折的疗效。方法对2011年9月至2012年11月采用髌上入路META—NAIL锁定型胫骨髓内钉治疗的18例胫骨干骨折患者的病例资料进行回顾性分析，男11例，女7例；年龄20～58岁，平均39岁。全部患者均为单侧骨折，行闭合复位内固定术治疗。术后3d开始在床上进行膝、踝关节无负重功能锻炼及下肢肌力训练。结果本组患者手术时间为60～90min，平均70．6min。未发生伤口感染、栓塞、软组织坏死等并发症。所有患者术后获6～10个月（平均8．5个月）随访，平均术后6周X线片可见骨痂出现，无骨不连、伤口感染、骨髓炎等并发症发生，4例患者小腿肌部分萎缩（最粗处周径较健侧缩小0．4～0．8cm），随访过程中无患者诉膝关节疼痛。Lysholm膝关节评分巾疼痛评分为21～25分，平均23．8分；总评分为82～93分，平均89分。结论髌上入路META—NAIL锁定型胫骨髓内钉治疗胫骨干骨折是一种微创的治疗方法，术巾对胫骨干多段骨折及近干骺端骨折的复位、固定操作简单，是治疗特殊类型胫骨骨折的有益补充。Objective To investigate the therapeutic effect of Meta-nailing for tibial fractures via the supra-patellar approach. Methods Eighteen patients, 11 males and 7 females, were enrolled in this study who had been treated in our department from September 2011 to November 2012 for tibial metaphyseal or segmental fracture. Their average age was 39 years （range, 20 to 58 years） . All tire fractures were closed unilateral ones which were treated with closed reduction and internal fixation with TRIGENTM META-NAILTM via tire supra-patellar approach. Muscular strength training and functional exercise without weight bearing commenced 3 days postoperatively. Results The average operating time was 70.6 minutes （range, 60 to 90 minutes）. No postoperative complications like infection, embolism or necrosis occurred. The patients were followed up regularly with a mean time of 8.5 months （range, 6 to 10 months） . Bony callus was shown on X-ray films 6 weeks postoperation ou average. No nonunion, infection or osteomyelitis was observed. Partial atrophy of the calf occurred in 4 eases （from 0. 4 to 0. 8 cm）. There was no complaint of anterior knee pain among all the patients. The pain scores in Lysholm knee scoring system ranged from 21 to 25 points （average, 23.8 points） and the total scores ranged from 82 to 93 points （average, 89 points）. Conclusions As a mini-invasive method, Meta-nailing via the supra-patellar approach is superior to traditional tibial nailing be- cause of its simplicity in reduction and fixation for tibial segmental and metaphyseal fractures. It can be an effective option for special types of tibial fracture.

关 键 词：胫骨 骨折 骨折固定术 内 骨钉 髌上入路 

分 类 号：R687.3[医药卫生—骨科学]