Yang Yu-Sheng, Ye Jia-Kuan, Fang Yong
The Second Department of Orthopaedics, the First People's Hospitalof Xiaoshan, Hangzhou 311201, Zhejiang, China.
Zhongguo Gu Shang. 2021 May 25;34(5):452-7. doi: 10.12200/j.issn.1003-0034.2021.05.011.
To explore clinical effects of intramedullary nailing through suprapatellar approach with semiextended position in treating tibial fractures.
From January 2018 to June 2019, 23 patients with tibia fractures were treated with suprapatellar approach intramedullary nailing on knee semiextended position, including 18 males and 5 females, aged from 26 to 67 years old with an average age of (38.5±9.6) years old. Eight patients were tibial proximal fractures, 7 patients were tibial shaft fractures, 6 patients were tibial distal fractures and 2 patients were tibial segmental fractures. Operation time, intraoperative blood loss, complications and fracture healing time were recorded. Range of motivation of knee joint between 3 days and 3 months after operation were compared, Hospital for Special Surgery (HSS) score and visual analogue scale (VAS) were used to evaluate clinical effects.
All patients were followed up from 8 to 19 months with an average of (12.3±7.6) months. Operation time was (55.3±5.1) min, intraoperative blood loss was (84.0±8.7) ml. No obvious complications occurred. All patients were achieved bony union at stageⅠ, fracture healing time ranged from 3 to 8 months with an average of (4.6±1.5) months. Flexion extension range of knee motion at 3 days after operation was (110.4±15.3)°, and increased to (123.7±16.5)° at 3 months after operation (=6.57, <0.001). Postoperative VAS at 3 days was (0.22±0.74) scores, and decreased to (0.04±0.20) scores at 3 months after operation (=1.09, >0.05). Postoperative HSS score at 6 months was 86.2± 11.5, and 19 got excellent result and 4 good.
Intramedullary nailing through suprapatellar approach with semiextended position in treating tibia fractureshas advantages of simple operation, less trauma for soft tissue, less pain, rapid recovery of function and less complication. It is especially suitable for patients with tibial multi-segment fracture and multiple fractures of ipsilateral lower limb for safety and simple.
探讨经髌上入路半伸直位交锁髓内钉治疗胫骨骨折的临床疗效。
选取2018年1月至2019年6月收治的23例胫骨骨折患者，采用髌上入路半伸直位交锁髓内钉治疗，其中男18例，女5例；年龄26～67岁，平均（38.5±9.6）岁。胫骨近端骨折8例，胫骨干骨折7例，胫骨远端骨折6例，胫骨多段骨折2例。记录手术时间、术中出血量、并发症及骨折愈合时间。比较术后3 d及3个月膝关节活动度，采用美国特种外科医院（HSS）评分及视觉模拟评分法（VAS）评价临床疗效。
所有患者均获随访，随访时间8～19个月，平均（12.3±7.6）个月。手术时间（55.3±5.1）min，术中出血量（84.0±8.7）ml。无明显并发症发生。所有患者均Ⅰ期骨性愈合，骨折愈合时间3～8个月，平均（4.6±1.5）个月。术后3 d膝关节屈伸活动度为（110.4±15.3）°，术后3个月增加至（123.7±16.5）°（=6.57，<0.001）。术后3 d VAS评分为（0.22±0.74）分，术后3个月降至（0.04±0.20）分（=1.09，>0.05）。术后6个月HSS评分为86.2±11.5分，优19例，良4例。
经髌上入路半伸直位交锁髓内钉治疗胫骨骨折具有操作简单、软组织损伤小、疼痛轻、功能恢复快、并发症少等优点，尤其适用于胫骨多段骨折及同侧下肢多发骨折患者，安全性高，操作简便。
