髌上与髌下置入髓内钉固定胫骨干骨折的比较

Comparison of suprapatellar and infrapatellar intramedullary nails for internal fixation of tibial shaft fractures

[目的]比较髌上与髌下入路髓内钉固定治疗胫骨干骨折的疗效。[方法]前瞻性选择2012年1月~2018年12月本院收治的80例胫骨干骨折患者为研究对象,根据随机数字表法随机分为髌上组及髌下组,每组40例。髌上组采用髌上入路META髓内钉固定,髌下组采用髌下入路普通髓内钉固定。比较两组患者的围手术期、随访和影像资料。[结果]髌上组手术时间、失血量均显著优于髌下组(P<0.05),而两组患者早期并发症发生率的差异无统计学意义(P>0.05)。髌上组下地行走时间、完全负重活动时间均显著早于髌下组(P<0.05)。术后6、12个月,髌上组的VAS评分、ROM和HSS评分显著优于髌下组(P<0.05)。影像方面,髌上组骨折复位质量显著优于髌下组(P<0.05),髌上组骨折愈合时间显著早于髌下组(P<0.05)。[结论]髌上入路髓内钉固定治疗胫骨干骨折的临床疗效优于髌下入路髓内钉固定。

[Objective] To compare the clinical efficacy of suprapatellar and infrapatellar intramedullary nails for internal fixation of tibial shaft fractures. [Methods] A total of 80 patients who admitted to our hospital from January 2012 to December 2018 for tibial shaft fractures were prospectively selected into this study, and divided into suprapatellar group and infrapatellar group by random number table method, with 40 patients in each group. The patients in the suprapatellar group had fractures fixed through the suprapatellar approach with META intramedullary nail, whereas those in the infrapatellar group got fracture reduction and internal fixation through the infrapatellar approach with ordinary intramedullary nail. The documents regarding to perioperative period, follow-up and imaging were compared between the two groups. [Results] The suprapatellar group was significantly better than the infrapatellar group in operation time and blood loss(P<0.05), but there was no significant difference in early complications between the two groups(P>0.05). The patients in the suprapatellar group returned to walking and full weight-bearing activity significantly earlier than those in the infrapatellar group(P<0.05). At 6 months and 12 months after operation, the suprapatellar group were significantly superior to the infrapatellar group in the VAS score, ROM and HSS scores(P<0.05). In terms of imaging, the fracture reduction quality of the suprapatellar group was significantly better than that of the infrapatellar group(P<0.05), and the fracture healing time of the suprapatellar group was significantly earlier than that of the infrapatellar group(P<0.05). [Conclusion] The clinical outcome of suprapatellar approach intramedullary nail fixation for tibial shaft fractures is considerably better than that of infrapatellar approach counterpart.