不同手术入路对胫骨干骨折髓内钉固定术的疗效影响  

Efficacy of intramedullary nail fixation for the tretament of tibial shaft fracture with difference approachs

作　　者：李钰军[1] 罗焕 陈元庄[1] 黄多连 LI Yu-jun;LUO Huan;CHEN Yuan-zhuang;HUANG Duo-lian(Department of Orthopaedics of Limbs and Joints,Jiangmen Central Hospital,Jiangmen,529030,Guangdong,China)

机构地区：[1]江门市中心医院四肢关节骨科,广东江门529030

出　　处：《中国骨伤》2021年第5期394-399,共6页China Journal of Orthopaedics and Traumatology

摘　　要：目的:比较髌上入路、髌下正中和髌下旁入路髓内钉治疗胫骨干骨折的临床疗效。方法:自2012年6月至2018年6月,采用髓内钉治疗胫骨干骨折36例,按照手术入路不同分为髌上入路组、髌下正中入路组和髌下旁入路组。髌上入路组12例,男7例,女5例;年龄25~53(37.8±11.4)岁;AO分型A型4例,B型4例,C型4例。髌下正中入路组10例,男6例,女4例;年龄19~56(35.6±10.0)岁;AO分型A型3例,B型4例,C型3例。髌下旁入路组14例,男8例,女6例;年龄21~58(36.6±10.0)岁;AO分型A型4例,B型6例,C型4例。比较3组患者手术时间、术中出血量、透视次数、骨折愈合时间及并发症情况,采用Lysholm评分评价膝关节功能。结果:36例患者获得随访,时间12~18(15.0±3.0)个月。3组患者术中出血量、骨折愈合时间比较差异无统计学意义(P>0.05),髌上入路组与髌下正中、髌下旁入路组比较,手术时间、透视次数及并发症差异有统计学意义(P<0.05)。髌下入路组和髌旁入路组手术时间、透视次数、并发症比较差异无统计学意义(P>0.05)。髌上入路、髌下正中入路和髌下旁入路组Lysholm评分分别为(87.5±7.5)分、(78.2±6.7)分和(77.4±6.3)分,3组比较差异有统计学意义(P<0.05)。髌上入路组与其他两组在下蹲、爬楼梯、疼痛及总分方面比较差异有统计学意义(P<0.05)。髌下正中入路组与髌下旁入路组各项评分及总分比较差异无统计学意义(P>0.05)。结论:髌上入路髓内钉治疗胫骨干骨折便于骨折复位和膝关节功能恢复,髌下正中入路和髌下旁入路有利于进钉点显露。3种入路各有优缺点,术者可结合自身经验进行选择。Objective:To compare clinical effect of intramedullary nailing through suprapatellar,infrapatellar and paracpatellar approach in treating tibial shaft fracture.Methods:From June 2012 to June 2018,36 patients with tibial shaft fracture were treated with intramedullary nails,and were divided into three groups according to surgical approach.Twleve patients were through suprapatellar approach,including 7 males and 5 females aged from 25 to 53 years old with an average of(37.8±11.4)years old;and 4 patients were type A,4 patients were type B,and 4 patients were type C according to AO classification.Ten patients were through infrapatellar approach,including 6 males and 4 females aged from 19 to 56 years old with an average of(35.6±10.0)years old;and 3 patients were type A,4 patients were type B,and 3 patients were type C according to AO classification.Forteen patients were through paracpatellar approach,including 8 males and 6 females aged from 21 to 58 years old with an average of(36.6±10.0)years old;and 4 patients were type A,6 patients were type B,and 4 patients were type C according to AO classification.Operation time,intraoperative blood loss,fluoroscopy times,fracture healing time and complications among three groups were observed,and knee joint functions were evaluated by Lysholm score.Results:All patients were followed up from 12 to 18 months with an average of(15.0±3.0)months.There were no difference in intraoperative blood loss and fracture healing time among three groups(P>0.05).There were statistical difference in operation time,fluoroscopy times and complications compared with suprapatellar approach and infrapatellar approach,paracpatellar approach(P<0.05).While there were no difference in operation time,fluoroscopy times and complications between infrapatellar approach and paracpatellar approach(P>0.05).Lysholm score among suprapatellar approach,infrapatellar approach and paracpatellar approach were(87.5±7.5),(78.2±6.7)and(77.4±6.3)respectively,and had differences among three groups(P<0.05).Compared

关 键 词：胫骨骨折 骨折固定术 内 外科手术 

分 类 号：R683.42[医药卫生—骨科学]