髌上入路与髌下入路髓内钉治疗胫骨干骨折的疗效分析  

Analysis of the Curative Effect of Suprapatellar Approach and Infrapatellar Approach Intramedullary Nail in the Treatment of Tibial Shaft Fracture

作　　者：宋高明 潘宏[1,2] SONG Gaoming;PAN Hong(Anqing Medical Center of Anhui Medical University,Anqing,Anhui Province,246000 China;Fifth Affiliated Hospital of Anhui Medical University,Anqing,Anhui Province,246000 China)

机构地区：[1]安徽医科大学安庆医学中心,安徽安庆246000 [2]安徽医科大学附属第五临床医学院,安徽安庆246000

出　　处：《中外医疗》2022年第35期67-71,共5页China & Foreign Medical Treatment

摘　　要：目的 比较髌上入路和髌下入路髓内钉治疗胫骨干骨折的临床疗效,为胫骨髓内钉入路方法的选择提供指导。方法 回顾性分析2018年1月—2019年12月安徽医科大学安庆医学中心骨科收治的54例胫骨干骨折患者资料,均采用髓内钉内固定手术,根据手术入路的不同分为髌上入路组(25例)和髌下入路组(29例)。比较两组手术时间、术中出血量、术中X线透视次数、术中二次位移发生率、骨折愈合时间、术后膝前疼痛发生率、改良Lysholm膝关节评分及胫骨干骨折Johner-Wruhs功能评分。结果 髌上入路组手术时间、术中出血量、骨折愈合时间分别为(95.8±8.5)min、(77.6±12.5)mL、(100.5±10.6)d,与髌下入路组的(98.8±9.5)min、(80.7±14.6)mL、(103.6±11.4)d比较,差异无统计学意义(P>0.05);髌上入路组术中透视次数为(17.2±3.5)次,少于髌下入路组的(22.2±5.6)次,差异有统计学意义(t=-3.859,P<0.001);髌上入路组术中二次位移发生1例,少于髌下入路组的9例,差异有统计学意义(χ^(2)=4.835,P=0.028);术后6个月随访,髌上入路组髌骨膝前疼痛发生率、胫骨干骨折Johner-Wruhs评分优良率分别为8%、92%,优于髌下入路组的31%、69%,差异有统计学意义(χ^(2)=4.835、4.392,P=0.028、0.036);髌上入路组术后6个月改良Lysholm膝关节评分为(90.5±8.8)分,高于髌下入路组(79.6±7.9)分,差异有统计学意义(t=4.796,P<0.001)。结论 与髌下入路组相比较,髌上入路可避免切开髌腱等组织,降低术中二次位移率,减少髌前疼痛发生,术后膝关节功能评分高,能够早期功能锻炼,临床疗效满意。Objective To compare the clinical effects of suprapatellar approach and infrapatellar approach in the treatment of tibial shaft fractures,and provide guidance for the selection of tibial intramedullary nail approach.Methods Retrospective analysis of 54 patients with tibial shaft fractures admitted to the Department of Orthopaedics,Anqing Medical Center,Anhui Medical University from January 2018 to December 2019.All patients underwent intramedullary nail internal fixation.According to the different surgical approaches,they were divided into suprapatellar approach group(25 cases)and infrapatellar approach group(29 cases).The operation time,intraoperative blood loss,intraoperative X-ray fluoroscopy times,incidence of secondary displacement,fracture healing time,incidence of postoperative anterior knee pain,modified Lysholm knee score and Johner-Wruhs function score of tibial shaft fracture were compared between the two groups.Results The operation time,intraoperative blood loss and fracture healing time of the suprapatellar approach group were(95.8±8.5)min,(77.6±12.5)mL and(100.5±10.6)d,respectively,Compared the infrapatellar approach group(98.8±9.5)min,(80.7±14.6)mL and(103.6±11.4)d,respectively,the difference was not statistically significant(P>0.05).The number of intraoperative fluoroscopy in the suprapatellar approach group was(17.2±3.5)times,less than the infrapatellar approach group(22.2±5.6)times,the difference was statistically significant(t=-3.859,P<0.001);there were 1 case of secondary displacement in the suprapatellar approach group,less than 9 cases in the infrapatellar approach group,and the difference was statistically significant(χ^(2)=4.835,P=0.028).After 6 months of follow-up,At the 6-month follow-up,the incidence of patellar anterior knee pain and the excellent rate of Johner-Wruhs score in the suprapatellar approach group were in 8%and 92%,respectively,which were better than 31%and 69%of the in the infrapatellar approach group,the difference was statistically significant(χ^(2)=4.835,4.39

关 键 词：胫骨干骨折 髓内钉 髌上入路 髌下入路 

分 类 号：R687.3[医药卫生—骨科学]