Li Yujun, Luo Huan, Chen Yuan-Zhuang, Huang Duo-Lian
Department of Orthopaedics of Limbs and Joints, Jiangmen Central Hospital, Jiangmen, 529030, Guangdong, China.
Zhongguo Gu Shang. 2021 May 25;34(5):394-9. doi: 10.12200/j.issn.1003-0034.2021.05.002.
To compare clinical effect of intramedullary nailing through suprapatellar, infrapatellar and paracpatellar approach in treating tibial shaft fracture.
From June 2012 to June 2018, 36 patients with tibial shaft fracture were treated with intramedullary nails, and were divided into three groups according to surgical approach. Twleve patients were through suprapatellar approach, including 7 males and 5 females aged from 25 to 53 years old with an average of (37.8±11.4) years old;and 4 patients were type A, 4 patients were type B, and 4 patients were type C according to AO classification. Ten patients were through infrapatellar approach, including 6 males and 4 females aged from 19 to 56 years old with an average of (35.6±10.0) years old;and 3 patients were type A, 4 patients were type B, and 3 patients were type C according to AO classification. Forteen patients were through paracpatellar approach, including 8 males and 6 females aged from 21 to 58 years old with an average of (36.6±10.0) years old;and 4 patients were type A, 6 patients were type B, and 4 patients were type C according to AO classification. Operation time, intraoperative blood loss, fluoroscopy times, fracture healing time and complications among three groups were observed, and knee joint functions were evaluated by Lysholm score.
All patients were followed up from 12 to 18 months with an average of (15.0±3.0) months. There were no difference in intraoperative blood loss and fracture healing time among three groups (>0.05). There were statistical difference in operation time, fluoroscopy times and complications compared with suprapatellar approach and infrapatellar approach, paracpatellar approach (<0.05). While there were no difference in operation time, fluoroscopy times and complications between infrapatellar approach and paracpatellar approach (>0.05). Lysholm score among suprapatellar approach, infrapatellar approach and paracpatellar approach were (87.5±7.5), (78.2±6.7) and (77.4±6.3) respectively, and had differences among three groups (<0.05). Compared with suprapatellar approach and infrapatellar approach, paracpatellar approach, there were difference in squatting, climbing stairs, pain and total scores (<0.05);while there were no difference between infrapatellar and paracpatellar group (>0.05).
intramedullary nailing through suprapatellar for the treatment of tibial shaft fracture is benefit for fracture healing and recovery of knee joint function, while infrapatellar and paracpatellar approach have advantages in exposure of insertion point. We should select approach reasonably according to our experience.
比较经髌上、髌下及髌旁入路交锁髓内钉治疗胫骨干骨折的临床效果。
选取2012年6月至2018年6月采用交锁髓内钉治疗的胫骨干骨折患者36例，根据手术入路分为3组。经髌上入路12例，男7例，女5例；年龄25～53岁，平均（37.8±11.4）岁；AO分型：A型4例，B型4例，C型4例。经髌下入路10例，男6例，女4例；年龄19～56岁，平均（35.6±10.0）岁；AO分型：A型3例，B型4例，C型3例。经髌旁入路14例，男8例，女6例；年龄21～58岁，平均（36.6±10.0）岁；AO分型：A型4例，B型6例，C型4例。观察3组手术时间、术中出血量、透视次数、骨折愈合时间及并发症情况，采用Lysholm评分评价膝关节功能。
所有患者均获随访，随访时间12～18个月，平均（15.0±3.0）个月。3组术中出血量、骨折愈合时间比较，差异无统计学意义（P>0.05）。髌上入路分别与髌下入路、髌旁入路比较，手术时间、透视次数及并发症差异有统计学意义（P<0.05）；髌下入路与髌旁入路比较，手术时间、透视次数及并发症差异无统计学意义（P>0.05）。髌上、髌下及髌旁入路Lysholm评分分别为（87.5±7.5）、（78.2±6.7）、（77.4±6.3）分，组间比较差异有统计学意义（P<0.05）。髌上入路分别与髌下入路、髌旁入路比较，蹲位、上下楼梯、疼痛及总分差异有统计学意义（P<0.05）；髌下入路与髌旁入路比较差异无统计学意义（P>0.05）。
经髌上入路交锁髓内钉治疗胫骨干骨折有利于骨折愈合及膝关节功能恢复，髌下及髌旁入路在进针点显露方面有优势，应根据经验合理选择手术入路。
