髌上入路Meta髓内钉联合阻挡钉技术内固定治疗胫骨远端骨折的疗效分析

Locked Meta intramedullary nailing combined with poller nailing fixation for distal tibial fractures via a suprapatellar approach

目的探讨髌上入路Meta锁定型胫骨髓内钉联合阻挡钉技术内固定治疗胫骨远端骨折的临床疗效。方法2012年12月至2018年2月,回顾性分析应用髌上入路Meta锁定型胫骨髓内钉联合阻挡钉技术内固定治疗的22例胫骨远端骨折患者。其中,男18例,女4例;年龄21~58岁,平均38.8岁;右侧13例,左侧9例;所有骨折全部行闭合复位。术后定期复查X线片,采用美国特种外科医院(HSS)及Olerud-Molander踝关节评分系统评定术后膝和踝关节功能。结果 20例患者术后获8~48个月(平均26.5个月)随访,2例患者失随访。术后10~24周(平均18.5周)骨折全部愈合,无软组织感染、骨延迟愈合及内固定失败等并发症发生;末次随访时HSS膝关节功能评分为82~98分(平均93分),其中优16例,良4例;Olerud-Molander踝关节评分为88~96分(平均94.5分),其中优14例,良6例。结论髌上入路Meta锁定型胫骨髓内钉联合阻挡钉技术内固定治疗胫骨远端骨折具有复位方便、固定牢靠、术中透视方便和术后并发症少等优点。

Objective To evaluate the efficacy of locked intramedullary nail(TriGen®META Nail,Smith&Nephew®)and poller nailing on the treatment of distal tibial fractures via a suprapatellar approach.Methods From December 2012 to February 2018,22 patients(18 males and 4 females;average age,38.8 years;13 cases on the right side and 9 cases on the left side)of distal tibial fracture were received the above treatment.All the fractures of patients were received closed reduction.X-rays were conducted to determine the bone healing.The American hospital for special surgery(HSS)and Olerud-Molander scoring systems were used for assessment ofknee and ankle function.Results Twenty patients were followed up for 8 to 48 months(average,26.5 months),2 patients lost follow-up.Their fractures were all healed after 10 to 24 weeks(average,18.5 weeks).No complications such as tissue infection and delayed union and failure of internal fixation were observed.The mean HSS score was 82-98 points(average,93 points),in which 16 cases were considered as excellent and 4 cases were good.The Olerud-Molander score was 88-96 points(average,94.5 points),in which 14 cases were excellent and 6 cases were good.Conclusion Locked Meta intramedullary nail combined with poller nailing fixation via a suprapatellar approach may be effective and safe for patients suffering from distal tibial fractures,with easy reduction and perspective,dissection stable fixation,few complications and excellent therapeutic outcome.