髌上入路与髌下入路髓内钉治疗胫骨近端骨折的疗效比较  

Comparison of suprapatellar approach and infrapatellar approach in the treatment of proximal tibia fractures

作　　者：何昌军 张堃[1] 李庆达 熊晨 杨明义 路遥[1] 任程[1] 刘德印 许毅博 李明[1] 李忠[1] 马腾[1] HE Chang-jun;ZHANG Kun;LI Qing-da;XIONG Chen;YANG Ming-yi;LU Yao;REN Cheng;LIU De-ying;XU Yi-bo LI Ming;LI Zhong;MA Teng(Department of Trauma Orthopaedics,Xi'an Honghui Hospital,Xi'an Jiaotong University,Xi'an,Shaanxi,710054,China)

机构地区：[1]西安交通大学附属西安市红会医院创伤骨科,陕西710054

出　　处：《中国骨与关节杂志》2022年第12期946-951,共6页Chinese Journal of Bone and Joint

摘　　要：目的 分析探讨髌上入路与髌下入路髓内钉治疗胫骨近端骨折的临床疗效。方法 回顾性分析2016年6月至2019年6月我院收治的53例胫骨近端骨折患者临床资料。将纳入的病历资料根据手术方式分为研究组和对照组,研究组26例,男18例,女8例,年龄24~71岁,平均(48.85±13.60)岁;对照组27例,男16例,女11例,年龄25~80岁,平均(50.44±15.86)岁。研究组采用髌上入路髓内钉治疗,对照组采用髌下入路髓内钉治疗。比较两组患者术中出血量、手术时间、术中透视次数、骨折愈合时间、膝关节功能评分、膝前疼痛发生率、膝关节功能优良率、骨折残余成角畸形、辅助复位情况等。所有患者术后均至少随访12个月。结果 两组患者随访12~24个月,平均(16.43±3.39)个月。两组患者术中出血量、手术时间、骨折愈合时间、膝关节功能评分差异无统计学意义(P> 0.05),研究组术中透视次数(8.77±1.79)次、膝前疼痛发生率3.8%(1/26)、冠状面成角(2.14±0.84)°、矢状面成角(2.27±0.83)°、辅助复位情况15.4%(4/26)低于对照组(10.56±2.33)次、29.6%(8/27)、(2.67±0.82)°、(2.99±0.79)°、48.1%(13/27),差异均有统计学意义(P <0.05);研究组患者膝关节功能优良率84.6%(22/26)显著高于对照组59.3%(16/27),差异有统计学意义(P <0.05)。结论 髌上入路髓内钉治疗胫骨近端骨折可以减少医务人员及患者的辐射伤害,改善骨折复位质量和术后患者膝关节功能,降低术后膝前疼痛的发生率,具有较高的有效性和安全性。Objective To analyze and explore the clinical efficacy of suprapatellar and infrapatellar intramedullary nailing in the treatment of proximal tibial fractures. Methods A retrospective analysis was performed.Clinical data of 53 patients with proximal tibial fracture, admitted to Honghui Hospital affiliated to Xi’an Jiaotong University from June 2016 to June 2019, were analyzed. There were 26 patients in the study group with an average age of( 48.85 ± 13.60) years( range: 24-71 years), including 18 males and 8 females. In the control group, there were 27 patients with an average age of( 50.44 ± 15.86) years( range: 25-80 years), including 16 males and 11 females.The study group was treated with suprapatellar approach intramedullary nailing, while the control group was treated with suprapatellar approach intramedullary nailing. The intraoperative blood loss, operation time, intraoperative fluoroscopy frequency, fracture healing time, knee function score, incidence of anterior knee pain, excellent and good rate of knee function, residual angular deformity of fracture, and assisted reduction were compared between the two groups. All patients were followed for at least 12 months postoperatively. Results Patients in both groups were followed up for 12-24 months, with an average of( 16.43 ± 3.39) months. There were no significant differences in intraoperative blood loss, operative time, fracture healing time and knee function score between the two groups( P > 0.05). The frequency of intraoperative fluoroscopy( 8.77 ± 1.79), incidence of anterior knee pain 3.8%( 1/26),coronal angle( 2.14 ± 0.84) °, sagittal angle( 2.27 ± 0.83) °, and assisted reduction 15.4%( 4/26) in the study group were lower than those in the control group( 10.56 ± 2.33), 29.6%( 8/27),( 2.67 ± 0.82) °,( 2.99 ± 0.79) °, 48.1%( 13/27), and the differences were statistically significant( P < 0.05). The excellent and good rate of knee function in study group 84.6%( 22/26) was significantly higher than that in control group 59.3%( 16/27), and

关 键 词：胫骨骨折 骨钉 骨折固定术 内 

分 类 号：R683.4[医药卫生—骨科学]