胫骨干骨折采用髌上、髌下入路髓内钉治疗的疗效对比

Comparison of Therapeutic Effects of Suprapatellar Approach and Infrapatellar Approach Intramedullary Nail for Tibial Shaft Fractures

目的分析总结胫骨干骨折采用髌上入路与髌下入路髓内钉治疗的手术操作及疗效的差异。方法选取2014年11月至2015年11月期间于我院行胫骨干骨折闭合复位髓内钉内固定治疗的患者共34例,根据术式不同分为髌上入路组17例(甲组)和髌下入路组17例(乙组)。甲组男10例,女7例;年龄22~65岁,平均(45.2±15.5)岁。乙组男12例,女5例;年龄24~64岁,平均(46.4±12.8)岁。观察记录两组术中指标(手术时间、术中出血量、术中透视次数)及术后指标(术后并发症、骨折愈合率、骨折愈合时间、术后膝前疼痛发生率、术后Lysholm膝关节评分),并进行对比。结果甲组术中透视次数(8.8±1.2)次少于乙组(10.9±2.0)次,甲组膝前疼痛发生率(5.9%)远低于乙组(41.2%),甲组Lysholm膝关节评分(87.9分)高于乙组(83.9分),对比差异有统计学意义(P<0.05);两组在手术时间、术中出血量、术后并发症、骨折愈合率及愈合时间上对比差异无统计学意义(P>0.05)。结论胫骨干骨折的患者采用髌上入路髓内钉治疗较髌下入路术中透视次数更少、术后膝前疼痛发生率更低、术后膝关节功能恢复更好。

Objective To analyze the differences of surgical operation and therapeutic effect between the suprapatellar approach and the infrapatellar approach in treatment of tibial shaft fractures.Methods 34 patients with tibial shaft fractures were treated with intramedullary nail in our hospital during November,2014 to November,2015.They were selected and divided into two groups according to the operation,17 cases of the suprapatellar approach group（group A）and 17 cases of the infrapatellar approach group（group B）.The clinical date about operation time,amount of bleeding,number of fluoroscopy,postoperative complications,fracture healing rate,fracture healing time,incidence of postoperative knee pain,postoperative Lysholm knee score were compared in this study.Results The number of fluoroscopy in group A（8.8±1.2）was less than that in group B（10.9±2.0）,the incidence of knee pain in group A（5.9%）was significantly lower than that in group B（41.2%）,Lysholm knee score（87.9points）was higher than that in group B（83.9points）,the difference was statistically significant（P〈0.05）.There was no significant difference between the two groups in operation time,amount of bleeding,postoperative complications,fracture healing rate and healing time（P〈0.05）.Conclusion Patients with tibial shaft fractures treated with suprapatellar approach intramedullary nail had fewer fluoroscopy than infrapatellar approach,with a lower incidence of postoperative knee pain and better postoperative knee function recovery.