三种不同手术入路髓内钉治疗胫骨骨折的疗效比较

Comparison of three different surgical approaches forintramedullarynailing in the treatment of tibial frac⁃ture

目的探讨不同手术入路胫骨髓内钉治疗胫骨骨折的疗效。方法收集我院2018年1月至2019年1月住院行髓内钉内固定治疗的99例胫骨骨折患者,其中男69例,女30例,年龄为18~65岁,平均47岁,根据手术入路分为髌上入路组33例、髌下入路组30例、髌骨旁外侧入路组36例;比较三组患者手术时间、术中出血量、X线照射次数、住院时间、骨折愈合时间、Lysholm评分、膝前疼痛的发生率、内固定物取除时间、并发症发生率、临床疗效优良率,使用SPSS 22.0统计学软件进行统计学分析。结果手术时间、术中出血量、X线照射次数、住院时间及膝前疼痛发生率比较,均为髌旁外侧入路组最少,差异均有统计学意义(P<0.05);Lysholm评分比较,髌旁外侧入路组最高,差异有统计学意义(P<0.05);临床疗效优良率、并发症发生率、骨折愈合时间及内固定物取除时间比较差异均无统计学意义(P>0.05)。结论不同手术入路是影响胫骨骨折疗效的重要因素,髌旁外侧入路不损伤髌韧带及髌股关节面,手术时间短,术中透视次数少,膝前疼痛发生率低,并发症少,可优先选择。

Objective To compare the effect of three different surgical approaches for intramedullary nailing for tibia fractures.Methods A retrospective analysis was conducted of the 99 patients with tibial fracture who had been treated from January 2018 to 2019 and completed follow⁃ups,there were 69 males and 30 females,with an average age of 47 years(range from 18 to 65 years),33 were treated through suprapatellar approach,30 were treated through infrapatellar approach and 36 were treated through parapatellar approach,The operative time,blood loss,times of X⁃ray exposure,length of hospital stay,fracture healing time,lysholm scoring,anterior knee pain,removal time of internal fixation,complication rate and postoperative excellence rate were recorded and compared among the three groups.The data were analyzed by SPSS22.0.Results In the parapatellar approach group,the operative time,blood loss,times of X⁃ray exposure,length of hospital stay and anterior knee pain were shorter,the lysholm scoring was highest.The difference was statistically significant(P<0.05).There were no significantly difference in the postoperative excellence rate,complication rate,blood loss and removal time of internal fixation(P>0.05).Conclusion Different surgical approach are factors related to treatment of tibial fracture.The parapatellar approach for tibial fractures doesn′t injury of ligamentumpatellae and patellofemoral,it also has the advantages of shorter operative time,less times of X⁃ray exposure,less pain and fewer complications,may be choosed firstly.