侧卧位与仰卧位髌下入路交锁髓内钉内固定治疗胫骨干多段骨折的比较  

Comparison of clinical effect of lateral and supine position in intramedullary nailing for treatment of segmental tibial shaft fractures via infrapatellar approach

作　　者：赵金柱 李鹏 曲良 牛大伟 谭长龙 陶春生 ZHAO Jin-zhu;LI Peng;QU Liang;NIU Da-wei;TAN Chang-long;TAO Chun-sheng(Department of Orthopedics,No.971 Hospital of PLA Navy(Orthopedic Center for Severe Trauma of Qingdao),Qingdao,Shandong 266071,China)

机构地区：[1]中国人民解放军海军第九七一医院骨科一病区(青岛市重症骨伤救治中心重点学科),山东青岛266071

出　　处：《中国骨与关节损伤杂志》2022年第8期803-806,共4页Chinese Journal of Bone and Joint Injury

基　　金：青岛市医药科研指导计划项目(2020-WJZD202)。

摘　　要：目的 评估侧卧位髌下入路交锁髓内钉内固定治疗胫骨干多段骨折的临床疗效。方法 回顾性分析自2015-01—2019-12诊治的57例胫骨干多段骨折,25例采用侧卧位髌下入路交锁髓内钉内固定治疗(侧卧位组),32例采用仰卧位髌下入路交锁髓内钉内固定治疗(仰卧位组)。比较两组手术时间、术中出血量、X线透视时间、骨折愈合时间、并发症情况,以及术后12个月下肢功能LEFS评分。结果 57例均获得随访,随访时间12~37个月,平均19.12个月。与仰卧位组比较,侧卧位组手术时间更短,术中出血量更少,术中X线透视时间更少,术后骨折畸形愈合发生率更低,差异有统计学意义(P<0.05)。侧卧位组骨折愈合时间为(14.00±5.93)周,仰卧位组为(15.88±5.02)周,组间差异无统计学意义(P>0.05)。侧卧位组术后12个月下肢功能LEFS评分为(77.19±2.39)分,仰卧位组为(76.86±2.81)分,组间差异无统计学意义(P>0.05)。结论 侧卧位经髌下入路交锁髓内钉内固定治疗胫骨干多段骨折有效克服了常规手术取仰卧位的缺点,术中X线透视方便且透视时间减少,缩短了手术时间,减少了对助手的依赖,而且有效降低了术后骨折畸形愈合发生率,适合在基层医院推广应用。Objective To evaluate the clinical effect of lateral position in intramedullary nailing for treatment of segmental tibial shaft fractures via infrapatellar approach. Methods A retrospective study was performed on 57 cases of closed segmental tibial shaft fractures treated with interlocking intramedullary nailing via the infrapatellar approach from January 2015 to December 2019, 25 cases were treated by lateral position (lateral group) and 32 cases by supine position (supine group). Operative time, intraoperative blood loss, intraoperative fluoroscopy time, fracture healing time, complications and LEFS score of lower limb function 12 months after surgery were compared between the two groups. Results All 57 cases were followed up for 12-37 months, on average 19.12 months. Compared with the supine group, the lateral group had shorter operative time, less intraoperative blood loss, fewer intraoperative fluoroscopy, and lower incidence of malunion (P<0.05). Fracture healing time was (14.00± 5.93) weeks in the lateral group and (15.88±5.02) weeks in the supine group, and there was no significant difference between the two groups (P>0.05). The LEFS score of lower limb function 12 months after surgery was (77.19±2.39) in the lateral group and (76.86±2.81) in the supine group, with no statistical significance (P>0.05). Conclusion Lateral position effectively overcomes the disadvantages of conventional supine position in intramedullary nailing for treatment of segmental tibial shaft fractures via infrapatellar approach. It has the advantages of convenient fluoroscopy, shortens the operative time, reduces the dependence on the assistant, and effectively reduces the incidence of malunion. It is suitable for application in basic-level hospitals.

关 键 词：胫骨干多段骨折 交锁髓内钉 内固定 髌下入路 侧卧位 仰卧位 

分 类 号：R687.3[医药卫生—骨科学]