两种入路髓内钉固定治疗胫骨中下段骨折的短期疗效对比研究  

Comparison of the short-term therapeutic effect of two surgical approaches for intramedullary nailing in the treatment of tibial shaft fractures

作　　者：龚凯 刘相杰 杨红胜[1] 曾志谋 潘显明 屈波 GONG Kai;LIU Xiangjie;YANG Hongsheng;ZHEN Zhimou;PAN Xianming;QU Bo(Department of Orthopedics,The First Affiliated Hospital of Chengdu Medical College,Chengdu,Sichuan 610500,China)

机构地区：[1]成都医学院第一附属医院骨科,成都610500

出　　处：《重庆医学》2022年第S02期43-46,共4页Chongqing medicine

摘　　要：目的比较半伸膝位髌旁内侧入路与传统髌下入路髓内钉固定治疗胫骨中下段骨折的疗效。方法回顾性分析2019年5月至2021年1月该院收治的33例住院并行髓内钉内固定治疗的胫骨骨折患者的临床资料,根据不同手术入路分为A组(半伸膝位髌旁入路,14例)与B组(传统髌下入路,19例)。术中观察指标包括手术时间、术中出血量、X线照射次数等。随访期间观察指标包括骨折愈合时间,术前、术后2周、末次随访时患肢视觉模拟疼痛量表(VAS)评分,末次随访时Lysholm评分及Johner-wruhs疗效评分,以及并发症发生情况等。比较两组患者上述观察指标的差异。随访时间为12个月。结果两组患者术中出血量、骨折愈合时间、末次随访时Lysholm评分比较,差异均无统计学意义(P>0.05);A组患者手术时间明显短于B组,术中透视次数明显少于B组,Johner-Wruhs评分优良率明显高于B组,膝前痛发生率、并发症发生率均明显低于B组,差异均有统计学意义(P<0.05)。结论采取半伸直位髌旁内侧置入胫骨髓内钉治疗胫骨中下段骨折能减少手术时间及术中射线暴露,短期随访膝关节功能良好,疗效满意,术后膝前痛发生率低,是一种能有效治疗胫骨干骨折的手术方式。Objective To compare the short-term therapeutic effect of intramedullary nailing fixation in semi-extended position via extraarticular medial-patellar approach for tibial shaft fracture and in typical infra patellar approach.Methods Between May 2019 and January 2021,14 patients with tibial shaft fracture were treated with intramedullary nailing fixation in semi-extended position via extraarticular medial-patellar approach as A group while the other 19 patients was were treated by typical infra patellar approach as B group.The operation time,bleeding volume,fluoroscopy times were recorded as intraoperative observation Indicator.During the follow up period,healing time,complications,the incidence of anterior knee pain Lysholm score of knee joint functions,Johner-wruhs efficacy assessment at last follow-up and the complications were evaluated and compared within two groups.Results All patients were followed up for 12 months.The operation time was 55-125 minutes(mean,81.4 minutes).The bleeding volume was 70-150 mL(mean,94.6 mL)and the average intraoperative fluoroscopy times was 14.5(range 11 to 19).There were no statistically significant differences in bleeding volume,healing time,Lysholm score between the two groups.The good rate of Johnerwruhs efficacy assessment in group A was 100%while 84.2%in group B.There are four knee pain cases in group B while only one patient in group A.There are statistically significant differences in Johner-wruhs efficacy assessment,rate of knee pain and complications between the two groups.Conclusion Application of the intramedullary nailing fixation in semi-extended position via extraarticular medial-patellar approach is effective for tibial shaft fractures with less operation time and radiation exposure,low incidence of knee pain,satisfactory joint function.It is an effectively surgical approach for tibial shaft fractures.

关 键 词：胫骨中下段骨折 半伸膝位髌旁内侧入路 髌下入路 手术时间 术中透视 膝前痛 

分 类 号：R68[医药卫生—骨科学]