Al-Azzawi M, Davenport D, Shah Z, Khakha R, Afsharpad A
Trauma and Orthopedics Department, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Rd, London, SE1 7EH, UK.
J Clin Orthop Trauma. 2021 Jan 29;17:1-4. doi: 10.1016/j.jcot.2021.01.009. eCollection 2021 Jun.
Tibial shaft fractures are a relatively common injury and contemporary treatment includes on-axis fixation with a locked intramedullary nail in the majority of cases. The conventional technique is via an infrapatellar approach but currently there is a trend towards the use of a suprapatellar approach. We compared key variables including operative time, radiation exposure and early patient reported outcomes when adopting a suprapatellar approach to tibial nailing in our unit versus our previous experience of infrapatellar tibial nailing.
Twenty-eight consecutive patients with tibial fracture underwent tibial nailing via the suprapatellar (SPN) approach. Six patients in the study group were excluded due polytrauma and need for dual orthopaedic and plastic surgery management. We compared outcomes with our most recent 20 consecutive patients who had undergone tibial nailing via an infrapatellar (IPN) approach. Primary surgical outcomes were: operative time, radiation exposure and accuracy of entry point of the nail on both anteroposterior and lateral radiographs. Clinical outcomes included time to weightbearing, time to radiographic union and patient-reported outcome score (Lysholm score).
Forty-eight consecutive patients underwent intramedullary nail fixation for tibial shaft fractures and 42 were eligible for inclusion in our study (22 SPN vs 20 IPN). There were no significant differences in patient demographics or injury patterns between the two groups. Operative time and radiation exposure were significantly lower in the SPN group when compared to the IPN group (115 min vs 139 min ± 12.5) (36 cGY/cm vs 76.33 cGY/cm +/- 20.1). Furthermore, patients in the SPN group reported superior outcome scores at a mean follow up of 3 months (8-24 weeks) There were no observed differences in complication rate between groups and time of final clinical follow up at a minimum of 6 months.
Our study shows that adoption of the SPN approach requires minimal learning curve, and has the potential benefits of reduced operative time, radiation exposure and superior patient reported outcomes when compared to the conventional infrapatellar approach.
胫骨干骨折是一种相对常见的损伤，现代治疗方法在大多数情况下包括使用带锁髓内钉进行轴向固定。传统技术是通过髌下入路，但目前有使用髌上入路的趋势。我们比较了在我们科室采用髌上入路进行胫骨钉固定与我们之前髌下入路胫骨钉固定经验时的关键变量，包括手术时间、辐射暴露和患者早期报告的结果。
连续28例胫骨骨折患者通过髌上（SPN）入路进行胫骨钉固定。研究组中有6例患者因多发伤以及需要骨科和整形外科联合治疗而被排除。我们将结果与最近连续20例通过髌下（IPN）入路进行胫骨钉固定的患者进行了比较。主要手术结果包括：手术时间、辐射暴露以及在前后位和侧位X线片上髓内钉进针点的准确性。临床结果包括负重时间、影像学愈合时间和患者报告的结果评分（Lysholm评分）。
连续48例患者接受了胫骨干骨折的髓内钉固定，42例符合纳入我们研究的条件（22例采用SPN，20例采用IPN）。两组患者的人口统计学特征或损伤类型无显著差异。与IPN组相比，SPN组的手术时间和辐射暴露显著更低（115分钟对139分钟±12.5）（36 cGY/cm对76.33 cGY/cm +/- 20.1）。此外，在平均3个月（8 - 24周）的随访中，SPN组患者报告的结果评分更高。两组之间的并发症发生率以及至少6个月的最终临床随访时间没有观察到差异。
我们的研究表明，与传统的髌下入路相比，采用SPN入路所需的学习曲线最小，并且具有减少手术时间、辐射暴露以及患者报告的结果更好的潜在益处。
