髌下入路“4”字体位髓内钉内固定治疗胫骨干闭合性骨折疗效分析

Clinical Effect of Internal Fixation of Intramedullary Nailing for Closed Tibial Shaft Fractures under 4-font Position via Infra-patellar Approach

目的探讨髌下入路“4”字体位髓内钉固定治疗胫骨干闭合性骨折的临床疗效。方法采用回顾性病例对照研究分析2014年1月2018年1月行髌下入路髓内钉固定治疗的35例胫骨干闭合性骨折患者的临床资料,按术中体位分为“4”字体位组(n=18)和传统体位组(n=17)。比较两组手术时间、术中出血量、术中放射线透视次数、闭合复位成功率、骨折愈合时间、并发症发生率及末次随访时Johner-Wruhs功能评分。结果两组均顺利完成手术。组间比较,“4”字体位组手术时间、术中出血量、术中透视次数及闭合复位成功率均优于传统体位组,差异有统计学意义(P<0.05)。两组患者均获随访,随访时间12~18月,平均(14.34±1.77)个月,均获得骨性愈合。两组骨折愈合时间比较,“4”字体位组明显短于传统体位组,差异有统计学意义(P<0.05)。“4”字体位组术后并发症5例,其中术后髌骨下方手术切口浅表感染1例,膝关节疼痛4例;传统体位组并发症5例,其中髌骨下方手术切口浅表感染2例,膝关节疼痛4例。两组均未见手术切口坏死、骨筋膜室综合征、神经血管损伤、骨折畸形愈合、骨折不愈合及内固定失效等其他并发症。两组并发症率比较,差异无统计学意义(27.78%VS 29.41%,P>0.05)。末次随访Johner-Wruhs评分:“4”字体位组优9例,良6例,中2例,差1例;传统体位组优8例,良5例,中2例,差2例;两组优良率比较,差异无统计学意义(83.33%VS 76.47,P>0.05)。结论采用“4”字体位与传统体位行髌下入路髓内钉固定治疗胫骨干闭合性骨折,均可获得较好的临床疗效,且并发症少,但“4”字体位下操作更便捷,术中透视方便,明显缩短了手术时间,减少了术中出血,提高了骨折闭合复位率,更有利于骨折愈合,值得临床上推广。

Objective To evaluate the clinical effects of internal fixation of intramedullary nailing for closed tibial shaft fractures via infra-patellar approach under 4-font position.Methods The clinical data of 35 patients with closed tibial shaft fractures performed internal fixation of infra-patellar intramedullary nailing from January 2014 to January 2018 was analyzed retrospectively.All cases were divided into 4-font position group(n=18)and traditional position group(n=17)according to the intra-operative posture.The operation time,intra-operative blood loss,intra-operative fluoroscopy times,success rate of closed reduction,fracture healing time,incidence of complications and Johner-Wruhs functional score at the last follow-up were compared between the two groups.Results All operations were accomplished successfully.The operation time,intra-operative blood loss,radiation fluoroscopy times and success rate of closed reduction in the 4-font position group were better than those in the traditional position group(P<0.05).All cases were followed up for 12 to 18 months with an average of(14.34±1.77)months.The fracture healing time of the 4-font position group was significantly shorter than that of the traditional position group(P<0.05).Postoperative complications were found in 5 cases in both groups respectively,including 1 case of superficial infection of infrapatellar incision and 4 cases of knee joint pain in the 4-font position group,and 2 cases of superficial infection of infrapatellar incision and 4 cases of knee joint pain(one of them combined with incision superficial infection)in the traditional position group.No operative incision necrosis,osteofascial compartment syndrome,neurovascular injury,fracture malunion,nonunion and internal fixation failure and other complications occurred in both groups.There was no statistical difference in complication rate between the two groups(27.78%VS 29.41%,P>0.05).The Johner-Wruhs function scale of last follow-up showed excellence in 9 cases,good in 6 cases,fair in 2 cases and failure in one case in the 4-font position group,and excellence in 8 cases,good in 5 cases,fair in 2 cases and failure in 2 cases in the traditional group,and there was no remarkable difference in the fineness rate between the two groups(83.33%VS 76.47,P>0.05).Conclusion Both the 4-font position and traditional position can achieve ideal clinical effect during internal fixation of infrapatellar intramedullary nailing for closed tibial shaft fractures with less complication,but the surgery under the 4-font position is more convenient to operating and intraoperative fluoroscopy,and can shorten surgery time,decrease blood loss,increase the closed reduction rate and improve to fracture healing,which is worthy of clinical generalization.