髌上入路髓内钉技术在治疗胫骨多段骨折中的临床疗效研究  

The Clinical Effect of Suprapatellar Approach Intramedullary Nail in Treatment of Multiple Tibial FracturesGong

作　　者：龚大伟 邱志杰[1] 杨勇[1] 王良恩[1] 冯骞 王森 张腾飞 罗毅 王泰坤 Dawei;Qiu Zhijie;Yang Yong(Meishan People's Hospital,Meishan,Sichuan 620010,China)

机构地区：[1]眉山市人民医院骨科,四川眉山620010 [2]茂县人民医院外二科,四川茂县623200

出　　处：《四川医学》2024年第11期1236-1240,共5页Sichuan Medical Journal

摘　　要：目的通过对比分析髌上与髌下入路在治疗胫骨多段骨折中的临床疗效探讨髌上入路髓内钉技术在治疗胫骨多段骨折中的应用价值。方法回顾性分析我院2020年5月至2023年3月采用髓内钉治疗的41例胫骨多段骨折患者的临床资料,其中髌上入路组22例(SP组),髌下入路组19例(IP组)。记录并比较两组患者手术时间、术中出血量、透视次数、术后膝前痛发生率、术后并发症发生率、末次随访时临床疗效(Johne-Wruhs评分)、骨折愈合时间。结果所有患者均获随访,SP组平均随访时间为(16.55±9.24)月,IP组平均随访时间为(17.23±10.06)月,SP组手术时间、术中出血量、透视次数均低于IP组,差异有统计学意义(P<0.05),SP组并发症发生率为9.09%,明显低于IP组并发症发生率42.11%,差异有统计学意义(P<0.05),SP组患者骨折愈合时间为(11.2±0.61)周,IP组患者骨折愈合时间为(12.33±0.42)周,差异无统计学意义(P>0.05)。末次随访时临床疗效(Johne-Wruhs评分):SP组优良率95.24%,IP组优良率94.73%,两组比较差异无统计学意义(P>0.05)。结论髌上入路及髌下入路在治疗胫骨多段骨折中均能得到较好的临床疗效,但髌上入路在手术操作及患者舒适度方面优于髌下入路组,远期效果需进一步观察。Objective To compare and analyze clinical effects of suprapatellar and infrapatellar approach in the treatmen of multiple tibial fractures,and to explore application value of suprapatellar approach in treatment of multiple tibial fractures.Methods From May 2020 to March 2023,clinical data of 41 patients with multiple tibial fractures treated by suprapatellar and infrapatellar approach intramedullary nail in our hospital were retrospectively analyzed.Among which 22 patients recived suprapatellar approach(group SP),and 19 patients recived the infrapatellar approach(group IP).Surgical time,intraoperative bleeding volume,number of fluoroscopy sessions,incidence of postoperative knee anterior pain,fracture healing time and and incidence of postoperative complications were recorded and compared.At the last follow-up,clinical efficacy was evaluated using the Johne Wruhs score.Results All patints were followed up,group SP was followed up with an anverage of(16.55±9.24)months and group IP was followed up with an anverage of(17.23±10.06)months.Group SP was significantly fewer than group IP in terms of surgical time,intraoperative bleeding volume,number of fluoroscopy sessions(P<0.05).Group SP(9.09%)was significantly fewer than group IP(42.11%)in terms of incidence of postoperative complications(P<0.05).There were no significant differe in fracture healing time between group SP(11.2±0.61)weeks and group IP(12.33±0.42)weeks(P>0.05).There were no significant differe in Johne Wruhs score between group SP(excellent rate:95.24%)and group IP(excellent rate:94.73%)(P>0.05).Conclusion Both the suprapatellar and infrapatellar approaches have shown good clinical efficacy in the treatment of multiple tibial fractures.However,the suprapatellar approach is superior to the infrapatellar approach in terms of surgical operation and patient comfort,and further observation is needed for its long-term effects.

关 键 词：髌上入路 髌下入路 髓内钉 胫骨多段骨折 

分 类 号：R683.42[医药卫生—骨科学]