改良髌上入路交锁髓内钉内固定治疗胫骨干骨折

Modified suprapatellar approach with intramedullary nailing internal fixation for tibial shaft fractures

目的探讨改良髌上入路交锁髓内钉内固定治疗胫骨干骨折的优点及临床疗效。方法回顾性分析自2013-05-2016-12采用改良髌上入路交锁髓内钉内固定治疗的25例新鲜闭合性胫骨干骨折。取髌骨外上角上两横指作一长2~3 cm横形切口,进针点符合侧位在胫骨平台前缘与前侧皮质相邻处,正位在胫骨平台外侧棘的内侧面。结果 25例均获得12个月以上随访,随访时间平均12.8(12~18)个月。4例术后1个月出现不同程度膝前疼痛,未出现螺钉松动、主钉断裂、骨折不愈合及下肢深静脉血栓形成等并发症。术后X线片显示骨折均愈合,骨性愈合时间平均94.6(82~105)d。末次随访时疼痛VAS评分、膝关节活动度、膝关节HSS评分、膝关节Lysholm评分较术前明显改善,差异有统计学意义(P <0.05)。末次随访时采用HSS评分量表进行疗效评估:优19例,良6例。结论改良髌上入路交锁髓内钉内固定治疗胫骨干骨折具有微创、手术操作简单、术后膝前痛发生率低、骨折愈合快、膝关节功能恢复好等优点。

Objective To analyze the advantages and effectiveness of modified suprapatellar approach with intramedullary nailing internal fixation for tibial shaft fractures.Methods From May 2013 to December 2016,25 cases of fresh-closed tibial shaft fractures treated with modified suprapatellar approach with intramedullary nailing internal fixation were retrospective analyzed.A 2-3 cm transverse incision was made at two transverse fingers outer upper angle of the patella,and the insertion point was located at the junction of the lateral position at the anterior edge of the tibial plateau and adjacent to the anterior cortex and the anteroposterior position on the inner side of the lateral spine of the tibial plateau.Results All the 25 patients were followed up for more than 12 months,with an average follow-up time of 12.8 (12-18) months.Four patients complained of anterior knee pain at 1 month follow -up,no complications such as screw loosening,nail fracture,nonunion and lower extremity deep vein thrombosis were observed.Postoperative X-ray showed that all fractures healed,and the average healing time was 94.6 (82-105) days.At the last follow-up,the VAS score,range of motion,HSS score and Lysholm score of knee joint were significantly improved after operation and the differences were statistically significant (P <0.05).The HSS scoring scale was used to evaluate the efficacy at the last follow-up,19 cases were excellent and 6 cases good.Conclusion The modified suprapatellar approach with intramedullary nailing internal fixation for tibial shaft fractures has the advantages of minimally invasiveness,simple operation,low incidence of anterior knee pain after surgery,fast fracture healing,and good knee function recovery.