髌下旁入路与髌下正中入路在胫骨干骨折髓内钉固定中的应用对比研究  

Comparative study of the application of the infrapatellar approach and the median infrapatellar approach in intramedullary nail fixation of tibial shaft fractures

作　　者：董建阳 淳德勤 陈曦 Dong Jian-yang;Chun De-qin;Chen Xi(Department of Emergency Surgery,Yuxi Jianhe Hospital,Nanyang 474550,Henan,China;Department of Spine and Arthrosis,Yuxi Jianhe Hospital,Nanyang 474550,Henan,China)

机构地区：[1]南阳豫西健和医院急诊外科,河南南阳474550 [2]南阳豫西健和医院脊柱关节科,河南南阳474550

出　　处：《四川生理科学杂志》2025年第4期852-854,共3页

摘　　要：目的:对比研究髌下旁入路与髌下正中入路在胫骨干骨折髓内钉固定术中的临床疗效。方法:回顾性分析2022年4月至2024年6月期间本院收治的72例胫骨干骨折患者的临床资料。依据不同术式将患者分为髌下旁入路组(髌下旁入路行髓内钉固定,37例)和髌下正中入路组(髌下正中入路行髓内钉固定,35例)。分析比较两组的手术相关指标、疼痛程度[术后视觉模拟评分(Visual analogue scale,VAS)]、膝关节功能(Lysholm膝关节评分量表)及并发症发生情况。结果:髌下旁入路组的手术时间、术中出血量、手术创口及透视次数均显著低于髌下正中入路组(P<0.05)。术后,两组的VAS评分均降低,Lysholm膝关节评分均比术前显著升高(P<0.05)。术后4 w及12 w,髌下旁入路组VAS评分均显著低于髌下正中入路组,Lysholm膝关节评分均显著高于髌下正中入路组(P<0.05)。两组的并发症发生率无显著差异(P>0.05)。结论:髌下旁入路在胫骨干骨折髓内钉固定中相较于髌下正中入路具有更好的应用效果,其可缩短手术时间,减少术中出血量、手术创口及透视次数,降低术后疼痛反应,促进膝关节功能恢复。Objective:To compare the clinical efficacy of the parapatellar approach and the median infrapatellar approach in the fixation of intramedullary nail for tibial shaft fracture.Methods:The clinical data of 72 patients with tibial shaft fracture admitted to our hospital from April 2022 to June 2024 were retrospectively analyzed.Patients were divided into subpatellar approach group(37 cases)and subpatellar median approach group(35 cases)according to different operation methods.Surgery-related indexes,pain degree[visual analogue scale(VAS)],knee function(Lysholm knee scale)and complications of the two groups were analyzed and compared.Results:The operative time,intraoperative blood loss,operative wounds and fluoroscopy times of the infrapatellar approach group were significantly lower than those of the infrapatellar approach group(P<0.05).After surgery,VAS scores of both groups were decreased,and Lysholm knee joint scores were significantly increased compared with those before surgery(P<0.05).At 4 and 12 weeks after surgery,VAS scores in the infrapatellar approach group were significantly lower than those in the median infrapatellar approach group,and Lysholm knee scores were significantly higher than those in the median infrapatellar approach group(P<0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion:The infrapatellar approach is more effective than the median infrapatellar approach in intramedullary nail fixation of tibial shaft fracture.It can shorten the operation time,reduce the amount of intraoperative bleeding,the number of surgical wounds and X-ray,reduce postoperative pain response,and promote the functional recovery of knee joint.

关 键 词：髌下旁入路 髌下正中入路 胫骨干骨折 髓内钉固定 膝关节功能 

分 类 号：R687.3[医药卫生—骨科学]