胫骨髓内钉髌上入路和髌下入路对膝关节功能的影响比较  

Comparison of the influence of suprapatella and infrapatella approach of tibial intramedullary nail on knee joint function

作　　者：周剑[1] 王高远[1] 陆军勤 闫双根[1] 唐康 崔益亮[1] Zhou Jian;Wang Gaoyuan;Lu Junqin(Dept of Orthopaedics,The First Affiliated Hospital of Anhui Medical University,Hefei 230022)

机构地区：[1]安徽医科大学第一附属医院骨科,合肥230022

出　　处：《安徽医科大学学报》2021年第6期977-980,共4页Acta Universitatis Medicinalis Anhui

基　　金：安徽省自然科学基金(编号:1808085QH241)。

摘　　要：探讨采用后髌上入路和髌下入路植入胫骨髓内钉治疗胫骨干骨折对膝关节功能的影响。胫骨干骨折采用胫骨髓内钉治疗的患者85例,其中髌上入路植入40例(髌上入路组),髌下入路植入45例(髌下入路组),记录两组术中出血量和手术时间。术后12个月评估膝关节活动度(ROM)评分,使用膝关节美国特种外科医院(HSS)评分系统评估膝关节功能。两组患者术后均愈合良好,手术时间、术中失血量差异无统计学意义。术后12个月髌上入路组、髌下入路组,膝关节HSS总评分、疼痛评分和ROM评分分别为(97.78±4.14)、(97.11±5.90),(28.44±2.78)、(29.13±1.92),(21.47±2.50)、(21.73±1.26),两组间比较差异无统计学意义。在膝关节ROM评分中,髌下入路组(17.47±1.06)活动范围大于髌上入路组(16.85±1.49)(P=0.023)。髌上入路和髌下入路植入胫骨髓内钉治疗胫骨干骨折均可获得良好效果,但髌下入路组患者术后膝关节屈伸活动范围大于髌上入路患者,髌上入路植入法需要进一步研究以减少对股四头肌的损伤。To investigate the effect of tibial intramedullary nailing via suprapatellar and infrapatellar approaches on knee function after tibial shaft fracture.85 cases of tibial shaft fractures were treated with tibial intramedullary nailing,including 40 cases of suprapatellar approach(suprapatellar approach group)and 45 cases of infrapatellar approach(infrapatellar approach group).Range of motion(ROM)and Hospital of Special Surgery(HSS)coring system of knee joint were evaluated 12 months after operation.There was no significant difference in operation time and intraoperative blood loss between the two groups.12 months after operation,the total HSS score,pain score and functional activity score were(97.78±4.14),(28.44±2.78)and(21.47±2.50)for suprapatellar approach group respectively while they were(97.11±5.90),(29.13±1.92)and(21.73±1.26)for infrapatellar approach group respectively.There was no significant difference between the two groups.In the ROM score of knee joint,the range of motion of the infrapatellar approach group(17.47±1.06)was larger than that of the suprapatellar approach group(16.85±1.49)(P=0.023).Tibial intramedullary nailing via suprapatellar approach and infrapatellar approach can achieve good results in the treatment of tibial shaft fractures,but the range of knee flexion and extension in the infrapatellar approach group is larger than that in the suprapatellar approach group,so the suprapatellar approach needs further study to reduce the damage to quadriceps femoris.

关 键 词：胫骨干骨折 髌上入路 髌下入路 髓内钉 

分 类 号：R683.42[医药卫生—骨科学]