不同入路内固定术对胫骨干骨折患者术后功能恢复及并发症的影响

Effect of Internal Fixation with Different Approaches on Postoperative Functional Recovery and Complications in Patients with Tibial Shaft Fracture

目的分析比较半伸膝位髌旁外侧入路和髌下正中入路内固定术对胫骨干骨折患者术后功能恢复及并发症的影响。方法纳入安阳地区医院2020年1月至2023年1月收治的60例胫骨干骨折患者,采用随机数字表法将患者分成A组和B组,A组接受半伸膝位髌旁外侧入路内固定术治疗,B组接受髌下正中入路内固定术治疗,每组30例。手术后随访5个月,了解患者的骨折愈合情况。比较A组与B组患者手术时间、骨折愈合时间、出血量等手术相关指标;术前及术后5个月时A组与B组患者膝关节功能情况由特种外科医院(HSS)膝关节评分进行评估;观察并记录两组患者手术后并发症发生情况(软组织损伤、反应性水肿、畸形愈合)。结果A组与B组患者手术时间及术前HHS评分比较,差异无统计学意义(P>0.05);与B组相比较,A组住院时间、骨折愈合时间均较短,出血量较少,差异有统计学意义(P<0.05)。术后5个月,A组与B组HSS评分均较术前升高,且A组高于B组,差异有统计学意义(P<0.05)。相较于B组,A组术后并发症总发生率更低,差异有统计学意义(P<0.05)。结论与髌下正中入路比较,半伸膝位髌旁外侧入路可降低胫骨干骨折患者术后并发症发生风险,且膝关节功能恢复效果更为显著。

Objective To analyze and compare the effects of semi-extended knee lateral parapatellar approach and median infrapatellar approach on functional recovery and complications in patients with tibial shaft fracture.Methods Sixty patients with tibial shaft fracture admitted to Anyang District Hospital from January 2020 to January 2023 were included.The patients were divided into group A and group B by random number table method.Group A was treated with semi-extended knee parapatellar lateral approach for internal fixation,group B was treated with median approach for infrapatellar internal fixation,with 30 cases in each group.The patients were followed up for 5 months after the operation to understand the healing status of the fractures.The operative time,fracture healing time and blood loss were compared between group A and group B.The knee function of patients in group A and group B was evaluated by the knee joint score of hospital for special surgery(HSS)before surgery and 5 months after surgery.Postoperative complications(soft tissue injury,reactive edema,malunion)were observed and recorded in both groups.Results There was no statistical significant difference in surgical time and preoperative HHS scores between group A and group B patients(P>0.05).Compared with Group B,Group A had shorter hospitalization time,shorter fracture healing time,and less bleeding,with statistical significant differences(P<0.05).Five months after surgery,HSS scores in group A and group B were higher than those before surgery,and group A was higher than group B,with statistical significant differences(P<0.05).Compared to Group B,Group A had a lower overall incidence of postoperative complications,with statistical significant differences(P<0.05).Conclusion Compared with the median infrapatellar approach,semi-extended knee lateral parapatellar approach can reduce the risk of postoperative complications in patients with tibial shaft fractures,and the recovery effect of knee joint function is more significant.