膝关节半伸直位髌上入路胫骨髓内钉治疗胫骨近端骨折的有效性和安全性

Efficacy and safety of tibial intramedullary nailing in suprapatellar approach with semi-straight knee joint in the treatment of proximal tibial fractures

目的探究膝关节半伸直位髌上入路胫骨髓内钉治疗胫骨近端骨折的有效性和安全性。方法选取2014年11月至2018年10月于我院行手术治疗的144例胫骨近端骨折患者为研究对象,根据手术入路的不同将其分为对照组(n=71,膝关节极度屈曲位髌下入路)和研究组(n=73,膝关节半伸直位髌上入路)。比较两组的术中情况、术后情况、术后6个月的疗效、膝关节功能及术后膝关节疼痛发生情况。结果两组的术中出血量和手术时间无显著差异(P>0.05);研究组的透视次数显著少于对照组(P<0.05)。研究组的骨折愈合时间显著短于对照组(P<0.05);两组患者的部分负重和完全负重时间无显著差异(P>0.05)。研究组的疗效优良率显著高于对照组(P<0.05)。研究组的膝关节功能优良率显著高于对照组(P<0.05)。研究组的术后膝关节疼痛发生率显著低于对照组(P<0.05)。结论膝关节半伸直位髌上入路胫骨髓内钉治疗胫骨近端骨折的创伤小,患者术后恢复快,可提高手术疗效、改善患者的膝关节功能,同时减少了术后膝关节疼痛的发生,有效性和安全性均较高。

Objective To investigate the efficacy and safety of tibial intramedullary nailing in suprapatellar approach with semi-straight knee joint in proximal tibial fractures. Methods From November 2014 to October 2018, 144 patients with proximal tibial fracture who underwent surgical treatment in our hospital were selected as the study objects. According to the different surgical approaches, the patients were divided into control group(n=71, infrapatellar approach with extreme flexion knee joint) and study group(n =73, suprapatellar approach with semi-straight knee joint). The intraoperative condition, postoperative condition, efficacy, knee joint function at 6 months after operation and postoperative knee joint pain in the two groups were compared. Results There were no significant differences in the amount of intraoperative bleeding and operation time between the two groups(P >0.05);the number of fluoroscopy in the study group was significantly less than that in the control group(P<0.05). The fracture healing time of the study group was significantly shorter than that of the control group(P<0.05);there were no significant differences in the time of partial and complete weight-bearing between the two groups(P>0.05). The excellent and good rate of curative effect in the study group was significantly higher than that in the control group(P<0.05). The excellent and good rate of knee joint function in the study group was significantly higher than that in the control group(P <0.05). The incidence of postoperative knee pain in the study group was significantly lower than that in the control group(P<0.05). Conclusion Tibial intramedullary nailing in suprapatellar approach with semi-straight knee joint in the treatment of proximal tibial fractures has less trauma, rapid postoperative recovery, it can improve the surgical efficacy and the knee joint function of patients, and reduce the occurrence of postoperative knee joint pain, with high effectiveness and safety.