髌上入路、髌下入路胫骨髓内钉治疗胫骨干骨折的对比研究  

Comparison of suprapatellar and infrapatellar intramedullary nailing for tibial shaft fractures

作　　者：魏新程[1] 杨凌云[1] 刘军[1] 王国栋[1] WEI Xin-cheng;YANG Ling-yun;LIU Jun;WANG Guo-dong(Department of Orthopedics,the Second Affiliated Hospital of Nanjing Medical University,Nanjing 210000,China)

机构地区：[1]南京医科大学第二附属医院骨科,南京210000

出　　处：《创伤外科杂志》2020年第3期181-184,共4页Journal of Traumatic Surgery

基　　金：南京医科大学校基金重点项目(2017NJMUZD030)。

摘　　要：目的比较髌上入路和髌下入路胫骨髓内钉治疗胫骨干骨折的疗效,为胫骨髓内钉置入路径的选择提供依据。方法回顾性分析南京医科大学第二附属医院2015年9月—2017年12月收治的58例胫骨干骨折患者,男性42例,女性16例;年龄19~73岁,平均50.3岁。均采用髓内钉内固定手术,按手术入路分为髌上入路(SPN)组和髌下入路(IPN)组,各29例,统计并比较两组手术时间、出血量、骨折愈合、膝前疼痛、膝关节功能评分。结果定期电话及门诊随访13~20个月,平均15.6个月。SPN组手术时间(100.66±6.78)min短于IPN组(110.07±8.92)min;SPN组与IPN组相比,膝前疼痛程度较轻(VAS评分1.07±1.00 vs.1.66±1.40),膝关节功能评分较高(Lysholm评分96.28±4.08 vs.93.93±4.62,Oxford评分53.28±3.96 vs.51.17±3.55),P<0.05。SPN组与IPN组在出血量[(79.31±11.00)mL vs.(83.10±11.37)mL]、骨折愈合方面(RUST评分27.03±2.34 vs.26.72±2.20),差异无统计学意义,P>0.05。结论与髌下入路组相比,髌上入路髓内钉治疗胫骨干骨折,操作简便,手术时间短,术后膝关节功能评分高,值得临床推广。Objective To compare the effect of suprapatellar and infrapatellar intramedullary nailing for tibial shaft fractures,with the purpose of providing evidence for choosing internal fixation routines of tibial intramedullary nailing.Methods From Sep.2015 to Dec.2017,58 tibia shaft fracture patients were treated in Department of Orthopedics,the Second Affiliated Hospital of Nanjing Medical University.There were 42 males and 16 females,with an average age of 50.3 years(range,from 19 to 73 years).They were divided into suprapatellar intramedullary nailing(SPN)group and infrapatellar intramedullary nailing(IPN)group,with 29 patients in each group.All patients were treated with internal fixation of tibial intramedullary nailing.Operative time,blood loss,fracture healing,anterior knee pain and knee function score were recorded and compared between the two groups.Results A telephone follow-up survey was carried out for each patient,and the follow-up period was 15.6(13-20)months on average.In contrast to the IPN group,the SPN group had shorter operation time[(100.66±6.78)minutes vs.(110.07±8.92)minutes],lower VAS pain score(1.07±1.00 vs.1.66±1.40),and higher knee functional score(Lysholm score 96.28±4.08 vs.93.93±4.62,Oxford score 53.28±3.96 vs.51.17±3.55),P<0.05.There was no statistically significant difference in blood loss and fracture healing(P>0.05).Conclusion Compared with IPN,SPN for tibial shaft fractures is much better in terms of shorter operation time,and higher postoperative knee function score.As a simple and convenient method,it is worth to be popularized.

关 键 词：胫骨干骨折 髓内钉 入路 

分 类 号：R683.42[医药卫生—骨科学]