髌上与髌下旁入路髓内钉固定胫骨干骨折的比较  

Comparison of suprapatellar and infrapatellar approaches for intramedullary nailing of tibial shaft fractures

作　　者：李钰军[1] 吴振焕 朱英[1] 潘月帆 LI Yu-jun;WU Zhen-huan;ZHU Ying;PAN Yue-fan(Department of Traumatology and Orthopedics,Jiangmen Central Hospital,Jiangmen 529030,China)

机构地区：[1]江门市中心医院创伤骨科,广东江门529030

出　　处：《中国矫形外科杂志》2021年第12期1062-1066,共5页Orthopedic Journal of China

摘　　要：[目的]比较髌上旁入路和髌下旁入路髓内钉固定胫骨干骨折的临床结果。[方法] 2012年6月—2019年6月采用闭合复位髓内钉固定胫骨干骨折62例。其中30例取髌上旁入路(髌上组),32例取髌下旁入路(髌下组)。比较两组围手术期、随访和影像学资料。[结果]髌上组的手术时间、术中透视次数和切口长度均显著优于髌下组(P<0.05),但两组间术中失血量和住院时间的差异无统计学意义(P>0.05)。两组患者随访12~18个月,平均(14.30±2.50)个月。两组恢复负重和完全负重活动时间的差异均无统计学意义(P>0.05)。随术后时间推移,两组患者活动时VAS评分显著下降(P<0.05),而膝关节ROM和Lysholm评分均显著增加(P<0.05)。术后6个月髌上组的VAS评分显著小于髌下组(P<0.05),术后6、12个月髌上组的Lysholm评分均显著高于髌下组(P<0.05)但相应术后时间点两组ROM的差异均无统计学意义(P>0.05)。影像方面,髌上组术后残留矢状面侧方移位和成角移位均显著小于髌下组(P<0.05),但是两组间术后残留冠状面侧方移位和成角移位的差异均无统计学意义(P>0.05)。两组影像显示骨折愈合时间的差异无统计学意义(P=0.080)。[结论]两种入路均可完成胫骨干骨折髓内固定,相比之下髌上旁入路的临床结果更优。[Objective] To compare the clinical outcomes of suprapatellar approach and the infrapatellar approach for closed reduction and internal fixation of tibial shaft fractures with intramedullary nail. [Methods] From June 2012 to June 2019, 62 patients underwent closed reduction and internal fixation with intramedullary nails for tibial shaft fractures in our department. Among them, 30 patients had operation performed through the suprapatellar approach(suprapatellar group), while the remaining 32 patients were by using the infrapatellar approach(infrapatellar group). The perioperative, follow-up and radiographic documents data were compared between the two groups. [Results] The suprapatellar group was significantly superior to the infrapatellar group in term of operation time, intraoperative fluoroscopy and incision length(P<0.05), nevertheless there was no statistically significant difference in intraoperative blood loss and hospital stay between the two groups(P>0.05). The patients in both groups were followed up for 12~18 months, with an average of(14.30±2.50) months. There was no significant difference between the two groups in the time of resuming weight-bearing and full weight-bearing activities(P>0.05).The VAS scores decreased significantly(P<0.05), while the knee ROM and Lysholm scores increased significantly in both groups over time postoperatively(P<0.05). The suprapatellar group was marked significantly lower VAS score at 6 months after surgery(P<0.05), whereas significantly higher Lysholm score at 6 and 12 months postoperatively than the infrapatellar group(P<0.05), despite of the fact that there were no statistically significant differences in ROM between the two groups at the time points postoperatively(P>0.05). In terms of imaging evaluation, the suprapatellar group had significantly less postoperative residual lateral displacement and angular displacement on sagittal plane than the infrapatellar group(P<0.05), but no statistically significant differences were noticed in residual lateral and angular di

关 键 词：胫骨干骨折 髓内钉 髌上旁入路 髌下旁入路 

分 类 号：R683.42[医药卫生—骨科学]