经髌上入路胫骨髓内钉治疗胫骨远段骨折

Treatment of distal tibial fractures with tibial intramedullary nail via suprapatellar approach

目的探讨经髌上入路胫骨髓内钉治疗胫骨远段骨折的疗效。方法采用经髌上入路胫骨髓内钉治疗32例胫骨远段骨折患者。记录手术情况,采用Johner-Wruhs评分评价功能恢复情况。结果患者均获得随访,时间6~18个月。手术时间64~100(84.94±8.50)min,术中出血量10~50(24.78±8.84)ml,术中透视次数18~52(28.16±7.24)次。骨折解剖复位11例,功能复位21例。术中无血管、神经损伤等严重并发症发生;术后无骨不连、力线不良、膝部疼痛等并发症发生。骨折均愈合,时间3.5~7.0(4.84±1.00)个月。末次随访时,膝关节活动度:屈曲120°~140°,伸直0°,患者步态均正常;采用Johner-Wruhs评分评价功能恢复情况:优19例,良10例,可3例,优良率90.6%(29/32)。结论经髌上入路胫骨髓内钉治疗胫骨远段骨折具有创伤小、手术时间短、易于操作及术后并发症少等优点。

Objective To investigate the effect of tibial intramedullary nail via suprapatellar approach in the treatment of distal tibial fractures.Methods Thirty-two patients with distal tibial fractures were treated with tibial intramedullary nail via suprapatellar approach.The operation conditions were recorded,and the functional recovery was evaluated by the Johner-Wruhs score.Results All the patients were followed up for 6~18 months.The operation time was 64~100(84.94±8.50)min,the intraoperative blood loss was 10~50(24.78±8.84)ml,and the intraoperative fluoroscopy times were 18~52(28.16±7.24)times.There were 11 cases of anatomical reduction and 21 cases of functional reduction.No serious complications such as vascular and nerve injury occurred during the operation,no postoperative complications such as nonunion,poor alignment,and knee pain occurred.All fractures healed within 3.5~7.0(4.84±1.00)months.At the last follow-up,the range of motion of the knee joint:120°~140°of flexion,0°of extension,and the patients′gait were all normal;Johner-Wruhs score was used to evaluate the functional recovery:excellent in 19 cases,good in 10,fair in 3,with an excellent-good rate of 90.6%(29/32).Conclusions The suprapatellar approach tibial intramedullary nail for the treatment of distal tibial fractures has the advantages of less trauma,shorter operation time,easier operation and fewer postoperative complications.