胫骨骨折髓内钉固定术髌下与髌上入路的比较

Comparison of Infrapatellar and Suprapatellar Approaches for Intramedullary Nail Fixation of Tibia Fractures.

作者信息

Metcalf Kathryn B, Du Jerry Y, Lapite Isaac O, Wetzel Robert J, Sontich John K, Dachenhaus Elizabeth R, Janes Jessica L, Ochenjele George

机构信息

Department of Orthopaedic Trauma Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH.

出版信息

J Orthop Trauma. 2021 Feb 1;35(2):e45-e50. doi: 10.1097/BOT.0000000000001897.

DOI:10.1097/BOT.0000000000001897

PMID:32658019

Abstract

OBJECTIVE

To assess clinical, radiographic, and functional outcomes after intramedullary nail (IMN) fixation of tibia fractures with an infrapatellar approach compared to a suprapatellar approach.

DESIGN

Retrospective chart review.

SETTING

Level 1 trauma center.

PATIENTS/PARTICIPANTS: Two hundred four patients with 208 tibia fractures treated with intramedullary nailing between 2008 and 2018.

METHODS

A retrospective chart review of tibia fractures was conducted. The clinical and functional outcomes of tibia fractures treated with IMN were compared between groups treated with an infrapatellar approach versus a suprapatellar approach. Multivariate models were created to control for confounding demographic, comorbidity, and injury-related confounders.

MAIN OUTCOME MEASUREMENTS

Outcome measures included nonunion, malunion, and infection. Subjective functional patient outcomes were assessed using pain interference and physical function Patient-Reported Outcome Measurements Systems scores.

RESULTS

There were 101 patients treated with infrapatellar nailing (49%) and 107 patients treated with suprapatellar nailing (51%). On multivariate analysis, suprapatellar nailing was independently associated with decreased risk of malunion (adjusted odds ratio, 0.165; 95% confidence interval, 0.054-0.501; P = 0.001) and decreased risk of postoperative knee pain (adjusted odds ratio, 0.272; 95% confidence interval, 0.083-0.891; P = 0.032). There was no difference in the rate of nonunion (P = 0.44), infection (P = 0.45), or Patient-Reported Outcome Measurements Systems pain interference or physical function scores.

CONCLUSIONS

Suprapatellar IMN fixation of tibial shaft fractures is independently associated with lower risk of malunion and postoperative knee pain compared to the infrapatellar approach. However, there are no functional differences between approaches.

LEVEL OF EVIDENCE

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

摘要

目的

评估采用髌下入路与髌上入路行髓内钉（IMN）固定胫骨骨折后的临床、影像学和功能结局。

设计

回顾性病历审查。

设置

一级创伤中心。

患者/参与者：2008年至2018年间204例接受髓内钉治疗的208例胫骨骨折患者。

方法

对胫骨骨折进行回顾性病历审查。比较髌下入路组与髌上入路组采用IMN治疗胫骨骨折的临床和功能结局。建立多变量模型以控制混杂的人口统计学、合并症和损伤相关混杂因素。

主要结局指标

结局指标包括骨不连、畸形愈合和感染。使用疼痛干扰和身体功能患者报告结局测量系统评分评估患者主观功能结局。

结果

101例患者采用髌下入路髓内钉固定（49%），107例患者采用髌上入路髓内钉固定（51%）。多变量分析显示，髌上入路髓内钉固定与畸形愈合风险降低独立相关（调整比值比，0.165；95%置信区间，0.054 - 0.501；P = 0.001），且术后膝关节疼痛风险降低（调整比值比，0.272；95%置信区间，0.083 - 0.891；P = 0.032）。骨不连发生率（P = 0.44）、感染发生率（P = 0.45）或患者报告结局测量系统的疼痛干扰或身体功能评分无差异。