侧卧位髌下内侧入路髓内钉治疗胫骨骨折效果

Clinical effect of intramedullary nail via the infrapatellar approachin the lateral position in treatment of tibial fracture

目的探讨侧卧位闭合复位髌下内侧入路髓内钉治疗胫骨骨折的技术优势和临床效果。方法胫骨骨折手术病人92例,随机分为侧卧位组和仰卧位组,各46例。比较两组手术时间、术中出血量、术中透视次数、复位质量及术后感染、骨折愈合情况、内固定失效等差异。结果侧卧位组手术时间、术中出血量、术中透视次数均显著少于仰卧位组(t=3.24~3.86,P<0.05);侧卧位组术后骨折端侧位X线片移位距离显著小于仰卧位组(t=3.53,P<0.05),但两组病人正位X线片移位差异无显著性(P>0.05);侧卧位组病人的术后骨折愈合时间、骨折愈合率、感染率、内固定失效率与仰卧位组比较,差异无统计学意义(P>0.05)。结论与仰卧位比较,侧卧位髌下内侧入路髓内钉治疗胫骨骨折具有手术时间短、术中出血少、透视次数少、节省人力、操作方便等优点。

Objective To investigate the technical advantage and clinical effect of closed reduction with intramedullary nail via the infrapatellar approach in the lateral position inthe treatment of tibial fracture.Methods A total of 92 patients who underwent surgery for tibial fracture were enrolledand divided into lateral position group and supine position group,with 46 patients in each group.The two groups were compared in terms of time of operation,intraoperative blood loss,times of intraoperative fluoroscopy,reduction outcome,postoperative infection,fracture healing,and internal fixation failure.Results Compared with the supine position group,the lateral position group had a significantly shorter time of operation and significantly lower intraoperative blood loss and times of intraoperative fluoroscopy(t=3.24-3.86,P<0.05),as well as a significantly smaller displacement distance onlateral X-ray of the fracture(t=3.53,P<0.05),but there was no significant difference in the displacement distance on anteroposterior X-ray between the two groups(P>0.05).There were no significant differences between the two groups in time to fracture healing,fracture healing rate,infection rate,and internal fixation failure rate(P>0.05).Conclusion Compared with surgery in the supine position,intramedullary nail via the infrapatellar approach in the lateral position has the advantages of short time of operation,low intraoperative blood loss,a low number of times of fluoroscopy,manpower saving,and convenient operation in the treatment of tibial fracture.