Väistö Olli, Toivanen Jarmo, Kannus Pekka, Järvinen Markku
Central Hospital of Seinäjoki, Seinäjoki, Finland.
J Trauma. 2008 Jun;64(6):1511-6. doi: 10.1097/TA.0b013e318031cd27.
Anterior knee pain is the most common complication after intramedullary nailing of the tibia. Dissection of the patellar tendon and its sheath during transtendinous nailing is thought to be a contributing cause of chronic anterior knee pain. The purpose of this long-term follow-up of a prospective, randomized study was to assess whether the prevalence and intensity of anterior knee pain after intramedullary nailing of a tibial shaft fracture is different in transtendinous versus paratendinous incision technique.
Fifty patients with a tibial shaft fracture requiring intramedullary nailing were randomized equally (25 plus 25) to treatment with paratendinous or transtendinous nailing. Forty-two patients (21 plus 21) were reexamined an average of 3 years after nailing, whereas 28 patients (14 plus 14) could be now reexamined an average of 8 years after the nailing. As in the first reexamination, the patients at the 8-year follow-up used visual analog scales to report the level of anterior knee pain and the impairment caused by the pain. The scales described by Lysholm and Gillquist and by Tegner et al., the Iowa knee scoring system, and simple functional tests were used to quantitate the functional results. Isokinetic thigh-muscle strength was also measured.
Four (29%) of the 14 patients treated with transtendinous nailing reported anterior knee pain at the 8-year follow-up evaluation. The number was the same for patients treated with paratendinous nailing. The Lysholm, Tegner, and Iowa knee scoring systems, the muscle-strength measurements, and the functional tests showed no significant differences between the two groups.
Compared with a transpatellar tendon approach, a paratendinous approach for nail insertion does not reduce the prevalence of chronic anterior knee pain or functional impairment after intramedullary nailing of a tibial shaft fracture. In long term, anterior knee pain seems to disappear from many patients.
膝前痛是胫骨髓内钉固定术后最常见的并发症。经肌腱入路髓内钉固定时髌腱及其腱鞘的剥离被认为是慢性膝前痛的一个促成因素。这项前瞻性随机研究的长期随访目的是评估胫骨干骨折髓内钉固定术后，经肌腱入路与经肌腱旁入路技术相比，膝前痛的发生率和强度是否存在差异。
50例需要进行髓内钉固定的胫骨干骨折患者被平均随机分为两组（每组25例），分别接受经肌腱旁入路或经肌腱入路固定治疗。42例患者（每组21例）在钉固定术后平均3年接受复查，而28例患者（每组14例）目前可在钉固定术后平均8年接受复查。与首次复查一样，8年随访时患者使用视觉模拟量表报告膝前痛程度及疼痛所致功能障碍。采用Lysholm和Gillquist量表、Tegner等人的量表、爱荷华膝关节评分系统以及简单功能测试来量化功能结果。同时还测量了等速大腿肌肉力量。
在8年随访评估中，14例经肌腱入路固定治疗的患者中有4例（29%）报告有膝前痛。经肌腱旁入路固定治疗的患者中该数字相同。Lysholm、Tegner和爱荷华膝关节评分系统、肌肉力量测量以及功能测试显示两组之间无显著差异。
与经髌腱入路相比，经肌腱旁入路插入髓内钉并不能降低胫骨干骨折髓内钉固定术后慢性膝前痛的发生率或功能障碍。从长期来看，许多患者的膝前痛似乎会消失。
