Consultant Orthopaedic Trauma Surgeon Aberdeen Royal Infirmary, Aberdeen, UK.
Hospital 12 de Octubre, Madrid, Spain.
Bone Joint J. 2019 Sep;101-B(9):1138-1143. doi: 10.1302/0301-620X.101B9.BJJ-2018-1115.R2.
The aim of this study was to compare the incidence of anterior knee pain after antegrade tibial nailing using suprapatellar and infrapatellar surgical approaches.
A total of 95 patients with a tibial fracture requiring an intramedullary nail were randomized to treatment using a supra- or infrapatellar approach. Anterior knee pain was assessed at four and six months, and one year postoperatively, using the Aberdeen Weightbearing Test - Knee (AWT-K) score and a visual analogue scale (VAS) score for pain. The AWT-K is an objective patient-reported outcome measure that uses weight transmitted through the knee when kneeling as a surrogate for anterior knee pain.
A total of 53 patients were randomized to a suprapatellar approach and 42 to an infrapatellar approach. AWT-K results showed a greater mean proportion of weight transmitted through the injured leg compared with the uninjured leg when kneeling in the suprapatellar group compared with the infrapatellar group at all timepoints at all follow-up visits. This reached significance at four months for all timepoints except 30 seconds. It also reached significance at six months at 0 seconds, and for one year at 60 seconds.
The suprapatellar surgical approach for antegrade tibial nailing is associated with less anterior knee pain postoperatively compared with the infrapatellar approach Cite this article: 2019;101-B:1138-1143.
本研究旨在比较经髌上和髌下入路顺行胫骨钉固定后前膝痛的发生率。
共 95 例胫骨骨折需髓内钉治疗的患者随机分为髌上或髌下入路治疗。术后 4 个月、6 个月和 1 年采用阿伯丁膝关节负重试验-膝关节（AWT-K）评分和疼痛视觉模拟评分（VAS）评估前膝痛。AWT-K 是一种客观的患者报告结局测量，使用屈膝时通过膝关节传递的体重来替代前膝痛。
共有 53 例患者随机分为髌上组，42 例患者随机分为髌下组。在髌上组，与髌下组相比，所有随访时间点屈膝时受伤腿与未受伤腿的体重传递比例均较高。除 30 秒外，所有时间点在 4 个月时均有统计学意义。6 个月时 0 秒时和 1 年时 60 秒时也有统计学意义。
与髌下入路相比，顺行胫骨钉固定的髌上入路术后前膝痛发生率较低。
