Cao Xin, Tang Qingxiang, Zhou Bingxin, Xiao Wei, Chen Huijin
Department of Traumatic Orthopedics, Shengli Oilfield Central Hospital, Dongying, China.
Department of Clinical Laboratory, Shengli Oilfield Central Hospital, No. 31 Jinan Road, Dongying, Shandong, 257034, China.
J Orthop Surg Res. 2024 Dec 19;19(1):838. doi: 10.1186/s13018-024-05338-y.
To compare the efficacy of intramedullary nailing via the lateral parapatellar approach versus the infrapatellar approach in treating fractures at the tibial metaphyseal-diaphyseal junction.
A retrospective analysis was conducted on the clinical data of 45 patients with proximal or distal tibial fractures treated with intramedullary nailing via lateral parapatellar approach (n = 23) or infrapatellar approach (n = 22) between January 2019 and March 2023. We recorded and compared the operative time, intraoperative blood loss/fluoroscopies, success rate of closed reduction, anteroposterior and lateral entry point accuracy, postoperative infection, fracture healing time, as well as NRS pain scores, Lysholm knee function scores, and knee range of motion.
Both groups completed the surgery without any complications. The lateral parapatellar approach group had significantly better results regarding shorter operative time, less intraoperative blood loss, and fewer intraoperative fluoroscopies compared to the infrapatellar approach group (P < 0.05). All cases in the lateral parapatellar approach group achieved closed reduction, while 10 cases in the infrapatellar approach group required open reduction. Fractures in both groups healed successfully, without statistically difference in healing time (P > 0.05). The accuracy of anteroposterior and lateral entry points was better with lateral parapatellar approach (P < 0.05). At 3 and 12 months postoperatively, lateral parapatellar approach showed better Lysholm and NRS scores compared to infrapatellar approach (P < 0.05). Two groups had no significant difference in range of motion (P > 0.05).
Lateral parapatellar approach combined with the blocking screw technique provides superior clinical outcomes compared to infrapatellar approach in the treatment of proximal or distal tibial fractures, making it suitable for further investigation.
比较经髌旁外侧入路与髌下入路髓内钉治疗胫骨近、远端干骺端-骨干交界处骨折的疗效。
回顾性分析2019年1月至2023年3月期间采用髌旁外侧入路（n = 23）或髌下入路（n = 22）行髓内钉治疗的45例胫骨近端或远端骨折患者的临床资料。记录并比较手术时间、术中出血量/透视次数、闭合复位成功率、前后位和侧位进针点准确性、术后感染、骨折愈合时间，以及NRS疼痛评分、Lysholm膝关节功能评分和膝关节活动度。
两组均顺利完成手术，无任何并发症。与髌下入路组相比，髌旁外侧入路组在手术时间更短、术中出血量更少和术中透视次数更少方面有显著更好的结果（P < 0.05）。髌旁外侧入路组所有病例均实现闭合复位，而髌下入路组有10例需要切开复位。两组骨折均成功愈合，愈合时间无统计学差异（P > 0.05）。髌旁外侧入路的前后位和侧位进针点准确性更好（P < 0.05）。术后3个月和12个月时，髌旁外侧入路的Lysholm和NRS评分优于髌下入路（P < 0.05）。两组膝关节活动度无显著差异（P > 0.05）。
在治疗胫骨近端或远端骨折方面，与髌下入路相比，髌旁外侧入路联合阻挡螺钉技术具有更好的临床效果，适合进一步研究。
