胫骨骨折髓内针置入点对术后膝前痛发生的影响

The effect of the different insertion place of tibial intramedullary nailing on the incidence of anterior knee pain

目的探讨胫骨骨折髓内针不同置入点对术后膝前痛发生率的影响。方法回顾分析胫骨骨折髓内针固定患者158例的临床资料,根据髓内针置入点不同分为两组,对比两组术后膝前痛发生率、跪姿疼痛评分和蹲坐姿疼痛评分。利用SPSS12.0软件对两组数据进行统计学分析。结果本组患者158例,术后骨不连5例,术后感染2例,骨筋膜室综合征1例,无术后髌韧带断裂及髓内针断裂病例。术后愈合时间平均21.4周。经髌韧带入路组:术后AKP发生率为51.39%(37例),跪姿疼痛评价平均值为7.2;蹲坐姿疼痛评价平均值为5.8。髌韧带旁入路组:术后AKP发生率为48.84%,跪姿疼痛评价平均值为5.5;蹲坐姿疼痛评价平均值为5.5。统计学显示:两组术后AKP发生率无明显差异;跪姿疼痛平均值有统计学显著差异P<0.05,经髌韧带入路组明显高于髌韧带旁入路组;蹲坐姿疼痛平均值无统计学显著差异P>0.05。结论髌韧带旁入路置入髓内针并不能减少术后膝前痛的发生率,但可有效缓解膝前痛的症状。

Objective To discuss the effect of the different insertion place of tibial intramedullary nailing on the incidence of anterior knee pain. Methods We do a retrospective analysis of the clinical data of 158 cases with tibial intramedullary nailing. According to the insertion place,we devoided the cases to two groups and compare the result of incidence of anterior knee pain,the VAS Scores on Kneeling,the VAS Scores on Squatting. Results There are nonunion 5 cases,infection 2 cases,osteofascial compartment syndrome 1 case. No patellar tendon disrupt and nail brisement occurred. The average of healing time is 21. 4 weeks. The transtendinous nailing group： the incidence of AKP is 51. 39% ,the VAS Scores on Kneeling is 7. 2,the VAS Scores on Squatting is 5. 8. The paratendinous nailing group： the incidence of AKP is 48. 84% ,the VAS Scores on Kneeling is 5. 5,the VAS Scores on Squatting is 5. 5. There is a significant difference in VAS Scores on Kneeling. Conclusion A paratendinous approach for nail insertion does not reduce the incidence of AKP,but it can relief the AKP symptom effectively.