Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education (MAHE University), Manipal, Udupi, Karnataka 576104, India.
Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education (MAHE University), Manipal, Udupi, Karnataka 576104, India.
Injury. 2020 Aug;51(8):1879-1886. doi: 10.1016/j.injury.2020.05.008. Epub 2020 May 18.
To evaluate the clinical and radiological outcome of proximal third tibia fractures managed by suprapatellar nailing with a minimum follow-up of 12 months.
In our retrospective cohort study of 43 consecutive proximal third tibia fractures from January 2015 to September 2018 treated with intramedullary nailing through suprapatellar approach in semiextended knee position were included. The patients were followed up regularly at 6 weeks, 3 months, 4.5 months, 6 months, 12 months and every 6 months thereafter. At each visit patients were assessed for union, shortening and rotational alignment. The clinical outcome was analysed using Lower Extremity Functional Scale (LEFS) and anterior knee pain. The radiological outcomes are analysed by evaluating the radiographs for progression of fracture union and tibial alignments.
After fulfilling the exclusion and inclusion criteria, 43 out of 60 consecutive proximal third tibia fracture were included in the study with an average age of 38.4 years (20-71 years), follow up of 20.4 months (12-45 months) after the index procedure. The radiological union was achieved in 7.3 months (4-13 months). At the end of 1 year follow up, the average LEFS was 89.4% (60%-95%). 4 patients had Malunion - with 1 valgus and 3 anterior angulations, 8 delayed unions and 1 non-union (with bone loss- which required bone grafting). All the fractures united eventually. No incidence of anterior knee pain.
We recommend suprapatellar nailing in proximal third tibial fractures when meticulously performed using the current surgical principles and techniques with proper implant selection. It results in excellent clinical and radiological outcomes with minimal complications when compared to other modalities of management. Suprapatellar nailing is a viable option for proximal third tibia fractures due to its inherent advantages of positioning, perfect nail entry and placement. Additionally, noteworthy absence of anterior knee pain is an additional benefit of this technique.
评估采用髌上入路髓内钉治疗近端胫骨三分之一骨折的临床和影像学结果，随访时间至少为 12 个月。
我们进行了一项回顾性队列研究，纳入了 2015 年 1 月至 2018 年 9 月期间采用髌上入路半伸直位髓内钉治疗的 43 例连续近端胫骨三分之一骨折患者。患者定期在 6 周、3 个月、4.5 个月、6 个月、12 个月及此后每 6 个月进行随访。每次随访时，评估患者的愈合情况、缩短和旋转对线。临床结果采用下肢功能量表（LEFS）和前膝疼痛进行分析。通过评估骨折愈合和胫骨对线的 X 线片来分析放射学结果。
在满足排除和纳入标准后，在连续的 60 例近端胫骨三分之一骨折中，有 43 例符合研究标准，平均年龄为 38.4 岁（20-71 岁），指数手术后的平均随访时间为 20.4 个月（12-45 个月）。X 线片显示，骨折在 7.3 个月（4-13 个月）时愈合。在 1 年的随访结束时，平均 LEFS 为 89.4%（60%-95%）。4 例患者存在畸形愈合-其中 1 例为外翻，3 例为前向成角，8 例为延迟愈合，1 例为不愈合（伴有骨丢失，需要植骨）。所有骨折最终均愈合。无前膝疼痛发生。
我们建议在严格遵循当前手术原则和技术，并适当选择植入物的情况下，采用髌上入路髓内钉治疗近端胫骨三分之一骨折。与其他治疗方式相比，该方法具有良好的临床和放射学结果，并发症较少。由于髌上入路具有定位、完美的钉入口和放置等固有优势，因此是治疗近端胫骨三分之一骨折的可行选择。此外，该技术的另一个优点是显著不存在前膝疼痛。
