摘要
目的比较髌上入路和髌旁外侧入路治疗胫骨骨折的疗效。方法回顾性分析2018年10月至2022年2月中山大学附属第七医院和深圳大学附属华南医院骨科收治的86例胫骨骨折患者资料。纳入标准:采用髌上和髌旁外侧入路髓内钉治疗;术后随访≥12个月;18岁以上60岁以下。排除标准:病理性骨折;软组织条件差的开放性骨折;合并同侧股骨骨折;有活动性感染;有其他膝关节功能障碍、手术史及神经损伤;有早期膝骨关节炎;严重的重要脏器疾病及精神疾病。所有患者均予以髓内钉内固定治疗,其中髌上入路的44例,髌旁外侧入路的42例。比较二种手术方法在手术时长、术中出血量,术中C臂曝光次数、骨折愈合时间、特种外科医院评分(HSS)及Lysholm评分等方面的差异。计量资料的比较采用两独立样本t检验,计数资料的比较采用卡方检验。结果二者手术时长、术中出血量、骨折愈合时间、术后HSS及Lysholm评分差异均无统计学意义(均为P>0.05)。术中C臂曝光次数,髌上入路组明显多于髌旁外侧入路组,差异具有统计学意义(t=5.907,P<0.05)。结论髌上入路和髌旁外侧入路髓内钉治疗胫骨干骨折,均能有效恢复膝关节关节功能,有效避免膝前疼痛,值得临床推广应用,但髌上入路存在进入关节腔副损伤的争议、术中C臂透视次数较多及取出内固定需额外切口。
Objective To compare efficacy of suprapatellar and lateral parapatellar approaches in the treatment of tibial fractures.Methods A total of 86 tibial fracture patients admitted to the Department of Orthopedics of Seventh Affiliated Hospital of Sun Yat-sen University and Southern Hospital of Shenzhen University,from October 2018 to February 2022 were retrospectively analyzed.Inclusion criteria:tibial fractures treated with intramedullary nailing using the patellar and lateral entry approaches;follow-up period≥12 months;age between 18 and 60 years.Exclusion criteria:pathological fractures;open fractures with poor soft tissue conditions;concomitant ipsilateral femoral fractures;active infection;other knee joint dysfunctions,surgical history,and nerve injuries;early knee osteoarthritis;severe vital organ diseases,and mental disorders.The patients were all treated with intramedullary nailing.Among the patients,44 patients were operated via suprapatellar approach,while the other 42 patients were operated via lateral parapatellar approach.The operation time,intraoperative blood loss,the number of C-arm exposures,fracture healing time,Hospital for Special Surgery(HSS),and Lysholm score were compared between the two groups.The measurement data were analyzed by two-independent t test,and the enumeration data were analyzed by chi-square test.Results There was no statistically significant difference in the duration of surgery,intraoperative blood loss,fracture healing time,HSS and Lysholm scores after operation between the two groups(all P>0.05).The suprapatellar approach group presented more C-arm exposures during surgery than the lateral parapatellar approach group,the difference was statistically significant(t=5.907,P<0.05).Conclusions The intramedullary nail fixation with suprapatellar approach or the parapatellar lateral approach for the treatment of tibial fractures can effectively restore knee joint function and effectively avoid anterior knee pain,which is worthy of clinical application.However,there is a controvers
作者
刘瀚忠
黄生辉
万俊明
李家春
舒涛
Liu Hanzhong;Huang Shenghui;Wan Junming;Li Jiachun;Shu Tao(Department of Orthopedics of Seventh Affiliated Hospital of Sun Yat-sen University,Shenzhen 518107,China;Department of Orthopedics of Southern Hospital of Shenzhen University,Shenzhen 518111,China)
出处
《中华关节外科杂志（电子版）》
CAS
CSCD
2023年第6期795-801,共7页
Chinese Journal of Joint Surgery(Electronic Edition)
关键词
胫骨骨折
骨折固定术
髓内
骨钉
Tibial fractures
Fracture fixation,intramedullary
Bone nails
