两种入路髓内钉固定治疗胫骨骨折的疗效比较

Comparison effect of intramedullary nailing fixation with two kinds of approaches for treatment of tibial fractures

目的比较髌下入路与半伸膝位外侧髌旁入路髓内钉固定治疗胫骨骨折的临床疗效。方法将60例胫骨骨折患者根据手术入路方式的不同分为髌下入路组(30例,行髌下入路髓内钉固定)和髌旁入路组(30例,行半伸膝位外侧髌旁入路髓内钉固定)。记录两组手术情况,比较两组手术疗效。结果患者均获得随访,时间14~20个月。手术时间、术中出血量髌旁入路组短(少)于髌下入路组,但差异均无统计学意义(P>0.05);术中透视次数、术中二次移位及术后膝前痛例数髌旁入路组明显少于髌下入路组,差异均有统计学意义(P <0.05)。骨折愈合时间两组比较差异无统计学意义(P> 0.05)。末次随访时Lysholm膝关节评分髌旁入路组明显高于髌下入路组,差异有统计学意义(P <0.05)。术后未发生切口深部感染、皮肤坏死、骨髓炎及内固定失效等严重并发症。髌下入路组1例发生切口浅表感染,经加强换药术后3周切口愈合。结论髌下入路与半伸膝位外侧髌旁入路髓内钉固定治疗胫骨骨折均效果良好,但半伸膝位外侧髌旁入路可减少术中透视次数及二次移位发生,降低术后膝前痛发生率。

Objective To compare the clinical effect of the infrapatellar approach( IPA) and the lateral parapatellar approach( LPA) at the semi-extended position using intramedullary nailing for treatment of tibial fractures. Methods According to the surgical approaches,60 patients with tibial fractures were divided into the IPA group( 30 cases were treated with IPA) and the LPA group( 30 cases were treated with LPA at the semi-extended position). The operation conditions and the clinical effect of the two groups were recorded and compared. Results All cases were followed up for 14 ~ 20 months. The operative time and intraoperative blood loss in the LPA group were shorter( less)than those in the IPA group,while the differences were not statistically significant( P > 0. 05). The frequency of intraoperative fluoroscopy,intraoperative secondary displacement and the case number of postoperative anterior knee pain in the LPA group were significantly less than those in the IPA group,with statistically significant differences( P < 0. 05).There was no significant difference in fracture healing time between the two groups( P > 0. 05). At the last follow-up,Lysholm knee score in the LPA group was significantly higher than that in the IPA group,with statistically significant difference( P < 0. 05). No serious complications such as deep incision infection,skin necrosis,osteomyelitis or failure of internal fixation occurred. Only one case in the IPA group had superficial incision infection,and the incision was healed in 3 weeks postoperation after strengthening dressing change. Conclusions The IPA and LPA at the semi-extended position using intramedullary nailing for the treatment of tibial fractures are both effective. However,the LPA at the semi-extended position can reduce the number of times of intraoperative fluoroscopy and intraoperative secondary displacement,decrease the incidence of postoperative anterior knee pain.