髌旁入路髓内钉固定胫骨骨折的疗效分析

Analysis of Curative Effect of Tibial Fracture Fixed with Intramedullary Nail through Parapatellar Approach

目的:探讨髌旁入路髓内钉固定与钢板固定胫骨骨折的临床疗效,为该类骨折的手术方案选择提供参考依据。方法:研究基于前瞻性视角,以内固定治疗作为研究主体,参照传统切开复位钢板内固定技术,研究最佳手术固定方法。为此,设计样本均来自我院2021年6月-2022年5月收治的88例胫骨骨折患者。研究经随机数字表法分组,其中观察组44例,接受髌旁入路髓内钉固定治疗,对照组44例,接受传统钢板内固定治疗。比较2组手术相关指标、VAS评分、膝关节活动度、膝关节功能评分及并发症等。结果:观察组的辐射量明显少于对照组,手术时间长于对照组,术中出血量低于对照组,骨折愈合及住院时间比对照组更短(P<0.05);2组并发症发生率对比差异显著,以观察组发生率明显较低(P<0.05);2组手术前疼痛评分比较无明显差异(P>0.05),手术后24小时及3天,观察组疼痛评分明显低于对照组,2组对比差异显著(P<0.05);观察组术后1个月及3个月的膝关节活动度比对照组更大(P<0.05);2组术后6个月及12个月的膝关节活动度差异不显著(P>0.05);观察组术后1个月及3个月的Lysholm评分及IKDC评分,比对照组更高(P<0.05),2组术后6个月及12个月的膝关节功能评分对比差异不显著(P>0.05)。结论:相比传统的钢板内固定,髌旁入路髓内钉固定胫骨骨折的疗效显著,可有效改善关节功能,创伤小、并发症少,促使其快速康复,安全性较高,具有良好的临床应用前景。

Objective:To investigate the clinical efficacy of intramedullary nail fixation and plate fixation of tibial fractures through the parapatellar approach,and to provide reference for the selection of surgical schemes for such fractures.Methods:The study was based on a prospective perspective,with internal fixation as the main body of the study.Referring to the traditional open reduction and plate internal fixation technology,the best surgical fixation method was discussed.For this purpose,88 samples were designed,all from patients with tibial fractures treated in our unit from June 2021 to may 2022.The study was divided into groups by random number table,of which 44 cases in the study group were treated with intramedullary nailing through the parapatellar approach;44 cases in the control group were treated with traditional steel plate internal fixation;The reduction effect,ankle mobility loss,complications and postoperative quality of life(SF-36)were compared between the two groups.Results:the radiation of the study group was significantly less than that of the control group,the operation time was longer than that of the control group,the intraoperative blood output was lower than that of the control group,and the fracture healing and hospitalization time were shorter than that of the control group(P<0.05).There was signif-icant difference in the incidence of complications between the two groups.The incidence in the study group was significantly lower(P<0.05).There was no significant difference in the pain score between the two groups before operation(P>0.05).The pain score of the study group was significantly lower than that of the control group 24 hours and 3 days after operation(P<0.05);The range of motion of the knee joint in the study group at 1 and 3 months after operation was greater than that in the control group(P<0.05);There was no significant difference in the range of motion of knee joint between the two groups at 6 and 12 months after operation(P>0.05);Ly-sholm score and IKDC score in the study group were higher than those in the control group at 1 and 3 months after operation(P<0.05),and there was no significant difference in knee function score between the two groups at 6 and 12 months after operation(P>0.05).Conclusion:compared with traditional steel plate internal fixation,parapatellar intramedullary nail fixation of tibial fractures has a significant effect,which can effectively improve joint function,with less trauma and complications,promote its rapid rehabilitation,high safety,and has a good clinical application prospect.