采用髌旁外侧入路联合阻挡钉技术治疗胫骨临干骺区骨折的疗效分析  

Analysis of efficacy of lateral parapatellar approach combined with the poller screw technique in the treatment of tibial adjacent metaphyseal region fractures

作　　者：唐庆祥 武琳 朱锋 陈慧锦[1] 孟险峰[1] 曹鑫[1] Tang Qingxiang;Wu Lin;Zhu Feng;Chen Huijin;Meng Xianfeng;Cao Xin(Department of Traumatic Orthopedics,Shengli Oilfield Central Hospital,Dongying Trauma Orthopedic Center,Dongying 257000,China)

机构地区：[1]胜利油田中心医院创伤骨科东营市创伤骨科中心,东营257000

出　　处：《骨科临床与研究杂志》2025年第2期89-95,共7页Journal Of Clinical Orthopedics And Research

摘　　要：目的比较髌旁外侧入路与髌下入路髓内钉置入技术治疗胫骨临近干骺区骨折的疗效。方法回顾性分析2019年1月至2023年3月在胜利油田中心医院创伤骨科治疗的45例胫骨近端或远端骨折患者的临床资料,其中23例采用髌旁外侧入路,22例采用髌下入路。两组患者年龄、性别、致伤原因、骨折AO分型比较差异无统计学意义(P>0.05)。记录并比较两组患者手术时间、术中失血量、术中透视次数、闭合复位成功率、正侧位进针点、术后感染、骨折愈合时间,统计术后3、12个月数字评分法(NRS)评分、Lysholm膝关节功能评分以及膝关节活动度(ROM)。结果两组患者术中均无神经、血管损伤等并发症发生。髌旁外侧入路组的手术时间、术中失血量、术中透视次数均少于髌下入路组,且差异具有统计学意义(P<0.05)。髌旁外侧入路组全部病例完成闭合复位,髌下入路组有10例切开复位。两组患者骨折均愈合,愈合时间比较差异无统计学意义(P>0.05)。髌旁外侧入路组正、侧位进针点准确性优于髌下入路组(P<0.05)。术后3、12个月髌旁外侧入路组Lysholm评分、NRS评分均优于髌下入路组(P<0.05),两组膝关节ROM比较差异无统计学意义(P>0.05)。结论髌旁外侧入路联合阻挡钉技术治疗胫骨远或近端骨折的临床效果优于髌下入路,该治疗方法安全有效,术后功能恢复良好,适合进一步推广使用。Objective To compare the efficacy of the lateral parapatellar approach versus the infrapatellar approach for intramedullary nailing of tibial metaphyseal-diaphyseal junction fractures.Methods A retrospective analysis was conducted on the clinical data of 45 patients with proximal or distal tibial fractures treated at the Department of Traumatic Orthopedics,Shengli Oilfield Central Hospital from January 2019 to March 2023.Among them,23 cases underwent the lateral parapatellar approach,and 22 cases underwent the infrapatellar approach.Metrics included operative time,blood loss,fluoroscopy use,closed reduction rate,entry point accuracy,infection,healing time,NRS pain scores,Lysholm scores,and knee range of motion(ROM)at 3 and 12 months.Results There were no intraoperative complications,including nerve or vascular injuries in either group.The lateral parapatellar approach yielded shorter operative times,less blood loss,and fewer fluoroscopies(P<0.05).It achieved 100% closed reduction versus 10 open reductions in the infrapatellar group.Fracture healing was achieved,with no statistically significant difference in healing time between them.The lateral parapatellar approach also had better entry point accuracy and superior Lysholm and NRS scores at 3 and 12 months(P<0.05),though knee ROM was similar across groups(P>0.05).Conclusion The clinical effect of the parapatellar lateral approach combined with the blocking screw technique in the treatment of distal or proximal tibial fractures is superior to that of the infrapatellar approach.This treatment method is safe and effective,and the postoperative functional recovery is good,which is suitable for further promotion and application.

关 键 词：胫骨骨折 骨折固定术 髓内 髌旁入路 阻挡钉 

分 类 号：R683.42[医药卫生—骨科学]