Department of Orthopaedics, University of Utah, Salt Lake City, UT.
Department of Orthopaedics, University of Nevada, Reno School of Medicine, Las Vegas, NV.
J Orthop Trauma. 2019 Jan;33(1):31-36. doi: 10.1097/BOT.0000000000001309.
To determine if an open, semi-extended, parapatellar tibial nailing technique (SEK) imparts any undue knee symptoms/pain compared with the traditional infrapatellar tibial nailing technique (FK).
Randomized controlled trial.
Level 1 trauma center.
Forty-seven patients with OTA/AO 42A-C tibial shaft fractures were included in the study.
Patients were randomized to treatment with either a SEK or an FK technique.
The main outcome was a symptoms subset of the International Knee Documentation Committee (SS-IKDC) pertaining to knee symptoms/pain.
Final follow-up was collected at 1 year for 24 SEK and 23 FK patients. No significant differences were found between the groups in regards to demographics, injury, or surgery-related variables. The 2 techniques did have equivalent symptoms scores [mean for the difference (SEK - FK): 0.29, 90% confidence interval: -4.16 to 4.75] but did not have equivalent pain scores [mean for the difference (SEK - FK): 0.2, 90% confidence interval: -3.18 to 3.59]. When comparing demographic and injury-related variables to the SS-IKDC, only Kellgren-Lawrence classification was statistically significant (P = 0.026), where increasing presence of osteoarthritis was associated with lower scores.
The results of this single-center randomized controlled trial show that SEK and FK techniques for tibial nailing are equivalent in regards to knee symptoms (defined as ±5 points on the SS-IKDC) but not specifically pain that showed trends toward decreasing knee pain with the open SEK technique. This randomized controlled trial demonstrates that the use of the open semi-extended, parapatellar technique for tibial nailing should not be associated with any higher likelihood of knee pain/symptoms than the traditional flexed knee, infrapatellar technique.
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
确定与传统髌下胫骨钉技术（FK）相比，开放式、半扩展、髌旁胫骨钉技术（SEK）是否会引起膝关节疼痛/不适等不必要的症状。
随机对照试验。
一级创伤中心。
47 例 OTA/AO 42A-C 胫骨骨干骨折患者纳入研究。
患者随机接受 SEK 或 FK 技术治疗。
主要结果是国际膝关节文献委员会（IKDC）膝关节症状/疼痛亚组的症状。
最终随访时间为 1 年，24 例 SEK 患者和 23 例 FK 患者完成随访。两组在人口统计学、损伤和手术相关变量方面无显著差异。两种技术的症状评分相当[差异的平均值（SEK-FK）：0.29，90%置信区间：-4.16 至 4.75]，但疼痛评分不同[差异的平均值（SEK-FK）：0.2，90%置信区间：-3.18 至 3.59]。当将人口统计学和损伤相关变量与 IKDC 进行比较时，只有 Kellgren-Lawrence 分级具有统计学意义（P=0.026），其中骨关节炎的存在程度与评分较低相关。
本单中心随机对照试验结果表明，SEK 和 FK 胫骨钉技术在膝关节症状方面（定义为 IKDC 评分±5 分）相当，但在特定疼痛方面，开放性 SEK 技术有降低膝关节疼痛趋势。本随机对照试验表明，与传统屈膝、髌下胫骨钉技术相比，使用开放式半扩展、髌旁技术进行胫骨钉固定不会增加膝关节疼痛/症状的可能性。
治疗水平 I. 有关证据水平的完整描述，请参见作者指南。
