髌上入路胫骨髓内钉治疗胫骨近端骨折  

Tibial intramedullary nailing using a suprapatellar approach for the treatment of proximal tibial fractures

作　　者：解冰[1] 杨超[1] 田竞[1] 周大鹏[1] 

机构地区：[1]沈阳军区总医院骨科,辽宁沈阳110016

出　　处：《中国骨伤》2015年第10期955-959,共5页China Journal of Orthopaedics and Traumatology

摘　　要：目的 ：探讨膝关节半伸直位髌上入路胫骨髓内钉治疗胫骨近端骨折的临床疗效。方法 ：2013年1月至2014年1月共收治胫骨近端骨折16例,男14例,女2例;年龄26~57岁,平均42.2岁。所有患者为单侧闭合骨折,采用膝关节半伸直位髌上入路META-NAIL胫骨髓内钉内固定治疗。记录手术时间、术后并发症、骨愈合时间、胫骨力线和膝关节活动范围,并采用视觉模拟评分法（visual analogue scale,VAS）和Lysholm膝关节评分评定手术疗效。结果：所有16例患者手术时间65~95 min,平均（75.7±8.3）min。无明显围手术期并发症发生。所有患者获随访,时间12~24个月,平均（15.6±8.1）个月。15例获得Ⅰ期骨愈合,平均骨愈合时间（3.6±1.8）个月（3~5个月）。末次随访时,所有患者胫骨力线良好,无膝前疼痛。患侧膝关节屈伸活动范围平均（124.4±18.8）°,健侧（127.5±16.7）°。Lysholm膝关节评分77~92分,平均86.4±12.3。结论：膝关节半伸直位髌上入路胫骨髓内钉治疗胫骨近端骨折,术中复位及固定操作方便,术后并发症少,患肢功能恢复良好,临床疗效满意。Objective：To study the clinical efficacy of semiextended intramedullary nailing of the tibia using a suprapatellar approach for proximal tibial fractures. Methods：From January 2013 to January 2014,a total of 16 patients with unilateral proximal tibial fractures,14 males and 2 females,underwent closed reduction and internal fixation with TRIGENTMMETANAILTMvia the suprapatellar approach. The average age was 42.2 years old（ranged,26 to 57 years old）. Radiographic and clinical follow up examinations were performed at a minimum of 1 year after surgery. Measurements included surgery time,complications,bone healing time,tibial alignment,knee range of motion,pain scoring（visual analogue scale） and functional outcome（Lysholm knee score）. Results：The average surgery time was（75.7 ±8.3） minutes（ranged,65 to 95 minutes）. No obvious complications were recorded. Average duration of follow up was（15.6±8.1） months（ranged,12 to 24 months）. Fifteen patients attained radiological bone union for a mean time of（3.6±1.8） months（ranged,3 to 5 months）. At the final follow up,all tibial alignments were good,and no patients complained of anterior knee pain. Mean arc of knee motion was（124.4±18.8）degrees for the affected extremity compared with（127.5±16.7） degrees for the contra lateral knee. The total scores of Lysholm knee score ranged from 77 to 92,average 86.4 ±12.3. Conclusion：For proximal tibial fractures,the semiextended intramedullary nailing technique via a suprapatellar approach can obtain satisfactory clinical outcomes with simplicity in reduction and fixation,minimal complications,and good recovery of limbs function.

关 键 词：胫骨 骨折 骨折固定术 内 

分 类 号：R683.42[医药卫生—骨科学]