髌旁入路髓内钉内固定治疗胫骨骨折的临床研究  

Clinical Study of Internal Fixation with Intramedullary Nail via Parapatellar Approach in the Treatment of Tibial Fracture

作　　者：徐菁 余伟 郑婧 XU Jing;YU Wei;ZHENG Jing(Department of Orthopedics,the First People's Hospital of Fuzhou,Fuzhou 344000,China;不详)

机构地区：[1]抚州市第一人民医院骨科,江西抚州344000

出　　处：《中国医学创新》2024年第19期25-29,共5页Medical Innovation of China

基　　金：抚州市指导性科技计划项目(抚科社字【2023】7号-20)。

摘　　要：目的:探究髌旁入路髓内钉内固定治疗胫骨骨折的临床效果。方法:选取2022年4月—2023年4月抚州市第一人民医院收治的78例胫骨骨折患者实施前瞻性研究,按照随机数字表法分为研究组(n=39)、对照组(n=39)。对照组实施髌下入路髓内钉内固定治疗,研究组实施髌旁入路髓内钉内固定治疗。比较两组临床疗效与复位不良发生率、临床指标、疼痛程度[视觉模拟评分法(VAS)]、膝关节功能[美国特种外科医院膝关节评分(HSS)]、并发症发生率。结果:与对照组比较,研究组临床疗效与优良率均更优,差异均有统计学意义(P<0.05);两组复位不良率比较,差异无统计学意义(P>0.05)。与对照组比较,研究组手术时间、骨折愈合时间、住院时间均更短,术中出血量更少,术后二次移位率更低,差异均有统计学意义(P<0.05)。两组VAS评分的时点效应、组间效应、交互效应比较,差异均有统计学意义(F_(时点)=1508.891,F_(组间)=18.349,F_(交互)=7.257,P<0.05);与入院时比较,出院时、术后3个月两组VAS评分均降低,且研究组均低于对照组,差异均有统计学意义(P<0.05)。两组HSS的时点效应、组间效应、交互效应比较,差异均有统计学意义(F_(时点)=1139.491,F_(组间)=10.657,F_(交互)=23.180,P<0.05);与出院时比较,术后3、6个月两组HSS均升高,且研究组均高于对照组,差异均有统计学意义(P<0.05)。与对照组(38.46%)相比,研究组并发症发生率(15.38%)更低,差异有统计学意义(P<0.05)。结论:髌旁入路髓内钉内固定治疗胫骨骨折有较好临床效果,可有效缓解疼痛,提高膝关节功能,降低并发症发生率,促进患者恢复。Objective:To explore the clinical effect of internal fixation with intramedullary nail via parapatellar approach in the treatment of tibial fracture.Method:A total of 78 patients with tibial fracture admitted to the First People's Hospital of Fuzhou from April 2022 to April 2023 were selected for a prospective study,and were divided into study group(n=39)and control group(n=39)according to random number table method.The control group was treated with internal fixation with intramedullary nail via infrapatellar approach,and the study group was treated with internal fixation with intramedullary nail via parapatellar approach.The clinical efficacy,incidence of poor reduction,clinical indexes,pain degree[visual analogue scale(VAS)],knee function[American hospital for special surgery knee score(HSS)]and complication rate were compared between the two groups.Result:Compared with the control group,the clinical efficacy and excellent and good rate of the study group were better,the differences were statistically significant(P<0.05).There was no significant difference in the poor reduction rate between two groups(P>0.05).Compared with the control group,the operation time,fracture healing time and hospital stay of the study group were shorter,the intraoperative bleeding volume was less,and the postoperative secondary displacement rate was lower,the differences were statistically significant(P<0.05).There were significant differences in time point effect,inter-group effect and interaction effect of VAS scores between the two groups(F_(time point)=1,508.891,F_(inter-group)=18.349,F_(interaction)=7.257,P<0.05).Compared with admission,VAS scores of both groups were lower at discharge and 3 months after surgery,and those in the study group were lower than those in the control group,the differences were statistically significant(P<0.05).There were significant differences in time point effect,inter-group effect and interaction effect of HSS between the two groups(F_(time point)=1,139.491,F_(inter-group)=10.657,F_(interaction)=23.

关 键 词：胫骨骨折 髓内钉内固定 髌旁入路 髌下入路 

分 类 号：R687.3[医药卫生—骨科学]