Rodríguez-Zamorano P, García-Coiradas J, Galán-Olleros M, Marcelo Aznar H, Alcobia-Díaz B, Llanos S, Valle-Cruz J A, Marco F
Departamento de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España.
Departamento de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Madrid, España.
Rev Esp Cir Ortop Traumatol. 2022 May-Jun;66(3):159-169. doi: 10.1016/j.recot.2021.09.008. Epub 2021 Nov 19.
Endomedullary nailing using the infrapatellar approach (IP) is considered the gold standard for the treatment of tibial diaphyseal fractures, however, it has been associated with greater difficulty in reduction and complications such as malalignment in procurvatum and anterior knee pain. The suprapatellar approach (SP) arises as an alternative to solve these aspects, also being associated with a shorter intraoperative time and a lower dose and fluoroscopy time.
Retrospective comparative study between a group of 22 fractures treated by SP approach and another of 30 fractures intervened by IP transtendinous approach. Perioperative variables were analyzed, as well as clinical, radiological, and functional aspects in outpatient visits at 3, 6 and 12 months.
No differences were found between groups in terms of intraoperative time, anemization, quality of reduction or complications during follow-up, among others. At 12 months, 12 (54.5%) SP cases and 16 (53.3%) IP presented anterior knee pain, without significant differences. In the evaluation scales, significant differences were recorded in the IKDC (International Knee Documentation Committee) in favor of the SP technique 88.45 (76.44-91.1) vs. IP 69 (49.95-80) (p=.006), with no significant differences in other functional scales analyzed.
According to what has been described so far in the literature, the present study supports the tendency toward SP nailing by improving the functional results (IKDC) in the medium term compared to the traditional IP technique, without increasing complications. Likewise, surgeons perceive greater technical ease for reduction and simplicity in obtaining intraoperative radiological images.
采用髌下入路（IP）进行髓内钉固定被认为是治疗胫骨干骨折的金标准，然而，它在骨折复位方面难度更大，且会引发诸如膝前凸畸形和前膝疼痛等并发症。髌上入路（SP）作为解决这些问题的一种替代方法应运而生，它还具有手术时间短、辐射剂量低和透视时间短的特点。
对一组采用SP入路治疗的22例骨折患者和另一组采用IP经肌腱入路治疗的30例骨折患者进行回顾性比较研究。分析围手术期变量以及术后3个月、6个月和12个月门诊时的临床、放射学和功能方面情况。
两组在手术时间、贫血情况、复位质量或随访期间的并发症等方面均未发现差异。在12个月时，12例（54.5%）采用SP入路的患者和16例（53.3%）采用IP入路的患者出现前膝疼痛，差异无统计学意义。在评估量表中，国际膝关节文献委员会（IKDC）评分有显著差异，SP技术组为88.45（76.44 - 91.1），IP技术组为69（49.95 - 80）（p = 0.006），而在分析的其他功能量表中无显著差异。
根据目前文献中的描述，本研究支持采用SP入路进行髓内钉固定的趋势，因为与传统的IP技术相比，该方法在中期可改善功能结果（IKDC评分），且不增加并发症。同样，外科医生认为SP入路在复位方面技术难度更低，获取术中放射影像更简便。
