半伸直位髌旁外侧入路髓内钉治疗胫骨下段骨折  

Lateral parapatellar approach intramedually nail for treatment of lower tibial fractures in the semi-extended position

作　　者：熊远飞 刘晖[1] 罗德庆[1] 张剑平 徐维臻 吴进[1] XIONG Yuan-fei;LIU Hui;LUO De-qing;ZHANG Jian-ping;XU Wei-zhen;WU Jin(Dept of Orthopaedics,the 909th Hospital,Dongnan Hospital of Xiamen University,Zhangzhou,Fujian 363000,China)

机构地区：[1]第九〇九医院(厦门大学附属东南医院)骨科,福建漳州363000

出　　处：《临床骨科杂志》2025年第1期113-116,共4页Journal of Clinical Orthopaedics

摘　　要：目的探讨半伸直位髌旁外侧入路髓内钉治疗胫骨下段骨折的疗效。方法采用半伸直位髌旁外侧入路髓内钉治疗37例胫骨下段骨折患者。记录手术时间、骨折愈合时间、并发症发生情况、膝踝关节活动度,采用Lysholm评分标准评价疗效。结果手术时间40~85(55.3±13.6)min。除1例失访外,36例患者获得随访,时间10~22(13.5±2.8)个月。骨折愈合时间3~6(4.6±2.3)个月。1例术后出现下段锁定置入区域浅表感染,1例出现髌旁入路切口浅表感染,1例下段横向交锁螺钉松动并向内突出。末次随访时,患侧膝关节伸直-10°~0°(-6.1°±1.8°),屈曲110°~135°(125.3°±10.6°);踝关节跖屈38°~49°(45.3°±2.8°),背伸20°~30°(26.8°±3.1°);膝关节功能Lysholm评分78~100(95.4±3.8)分,其中优27例,良7,差2例,优良率94.4%。结论采用半伸直位髌旁外侧入路髓内钉治疗胫骨下段骨折是一种实用、有效的手术方法,操作相对简单,术后并发症少。Objective To investigate the effect of lateral parapatellar approach intramedually nail for treatment of lower tibial fractures in the semi-extended position.Methods The 37 patients with lower tibial fractures were treated by lateral parapatellar approach intramedullary nail in the semi-extended position.The operative time,fracture healing time,complication incidence condition,and the activity range of knee-ankle joint were recorded,Lysholm score of knee joint function were observed.Results The operative time was 40~85(55.3±13.6)min.The other patients were followed up for 10~22(13.5±2.8)months,except one patient who was lost to follow-up.Superficial infection of the locking-placement region of the lower segment occurred in 1 case,superficial infection of the parapatellar approach incision occurred in 1 case,and the transverse interlocking screw of the lower segment became loosening and protruded inward in 1 case.At the last follow-up,the affected side activity was that knee joint extension and flexion was-10°~0°(-6.1°±1.8°),110°~135°(125.3°±10.6°);ankle joint plantar flexion was 38°~49°(45.3°±2.8°),and dorsal extension was 20°~30°(26.8°±3.1°),respectively.The Lysholm scores of knee joint function was 78~100(95.4±3.8)points.Among them,27 cases were excellent,7 cases were good,and 2 poor,the excellent-good rate was 94.4%.Conclusions The treatment of lower tibial fractures with lateral parapatellar approach intramedullary nail in the semi-extended position is a practical and effective surgical method,with relatively simple operation and few postoperative complications.

关 键 词：髓内钉 半伸直位 髌旁入路 胫骨下段骨折 

分 类 号：R683.42[医药卫生—骨科学] R687.33[医药卫生—外科学]