Choudri Mohammed Junaid, Hussain Shakir, Bleibleh Sabri, Remtulla Mohammedabbas, Karthikeyan Ravichandran, Cooper Julian
University Hospital Birmingham, Mindelsohn Way, Birmingham, B15 2GW, United Kingdom.
J Clin Orthop Trauma. 2023 Oct 21;45:102274. doi: 10.1016/j.jcot.2023.102274. eCollection 2023 Oct.
Tibial intramedullary nailing is a common method of fixation for fractures of the tibia, with several approaches described. Anterior knee pain is a common complication following nailing, but the reported incidence of knee pain varies in the literature between 10 % and 86 %. There is considerable variation in incidence between nailing techniques, with an exact aetiology still unknown. We investigated the reported incidence of anterior knee pain in patients undergoing tibial nailing using the semi-extended extra synovial (SEES) technique at a Major Trauma Centre (MTC) in the UK.
A retrospective review of tibial fractures treated with the SEES technique between December 2012 to February 2021. Data collected included patient demographics, mechanism of injury, fracture characteristics, length of stay, union rates and re-operation rates. Primary outcomes were anterior knee pain rates and patient reported outcome measures (PROM), the Kujala Score. Secondary outcomes were rates of union and complications.
55 fractures were identified in 53 patients. Male: Female ratio was 32:21. The average age was 45.5 years. 96 % were unilateral fractures; with 53 % being right-sided. 21(38 %) fractures were open. Prior to definitive nailing 21 fractures had temporary stabilisation with an external fixator (Ex-Fix) ± wound debridement whilst the rest received plaster backslab immobilisation. 13 of the open fractures required soft tissue cover. 75 % of patients had initial surgery (SEES Nailing/Ex-Fix) within 4 days. There was a 91 % union rate with a median time to full radiographic union of 14 months. One post-operative complication of wound dehiscence was recorded. The mean follow-up time was 13.6 months. 15 % of patients reported anterior knee pain in the postoperative follow-up period. The average Kujala PROM score was 85 (Range: 52-100).
CONCLUSION/FINDINGS: The SEES technique had favourable PROM scores and displayed a lower incidence of anterior knee pain than the traditional infrapatellar approach. Knee pain rates were comparable to suprapatellar approaches without violating the knee joint.
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胫骨髓内钉固定术是治疗胫骨骨折的常用方法，有多种入路方式。膝前疼痛是髓内钉固定术后的常见并发症，但文献报道的膝痛发生率在10%至86%之间。不同髓内钉技术的发生率差异很大，确切病因仍不清楚。我们调查了在英国一家主要创伤中心（MTC）采用半扩展滑膜外（SEES）技术进行胫骨髓内钉固定术患者的膝前疼痛报告发生率。
回顾性分析2012年12月至2021年2月间采用SEES技术治疗的胫骨骨折患者。收集的数据包括患者人口统计学资料、损伤机制、骨折特征、住院时间、骨愈合率和再次手术率。主要结局指标是膝前疼痛发生率和患者报告结局量表（PROM），即库贾拉评分。次要结局指标是骨愈合率和并发症发生率。
共识别出53例患者的55处骨折。男女比例为32:21。平均年龄为45.5岁。96%为单侧骨折，其中53%为右侧骨折。21处（38%）骨折为开放性骨折。在进行确定性髓内钉固定之前，21处骨折采用外固定架（Ex-Fix）临时固定并进行伤口清创，其余患者采用石膏后托固定。13处开放性骨折需要进行软组织覆盖。75%的患者在4天内接受了初次手术（SEES髓内钉固定术/外固定架固定术）。骨愈合率为91%，影像学完全愈合的中位时间为14个月。记录到1例术后伤口裂开并发症。平均随访时间为13.6个月。15%的患者在术后随访期间报告有膝前疼痛。库贾拉PROM评分的平均值为85（范围：52-100）。
结论/研究结果：SEES技术具有良好的PROM评分，与传统髌下入路相比，膝前疼痛发生率较低。膝痛发生率与不侵犯膝关节的髌上入路相当。
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