Santhanam Siva Swaminathan, Velayutham Sabaresh, Krishnan Ponnilavan, Albert Antony, Ramanujam Brinda
Orthopedics, Ysbyty Gwynedd, Bangor, GBR.
Orthopedics, Pondicherry Institute of Medical Sciences, Pondicherry, IND.
Cureus. 2024 Nov 28;16(11):e74682. doi: 10.7759/cureus.74682. eCollection 2024 Nov.
Intramedullary interlocking nailing is a common surgical procedure for tibial fractures, enabling early patient mobilization. Traditionally, the infrapatellar approach has been used for intramedullary interlocking nailing of tibial fractures, but the suprapatellar approach is gaining attention for its potential benefits. This randomized controlled study aimed to compare the duration of the surgery, intra-operative blood loss, and fluoroscopy time between the suprapatellar and infrapatellar approaches.
We included 38 adult patients with tibial shaft fractures, excluding those with non-union, open fractures, revision surgery, or low Glasgow Coma Scale (GCS). Patients were divided equally into two groups using block randomization: Group A (19 patients) underwent the infrapatellar approach, and Group B (19 patients) underwent the suprapatellar approach. Blood loss was measured using the gravimetric method and by changes in pre-operative and post-operative hemoglobin levels. Surgical duration by calculating the time elapsed between the start and end of the procedure and fluoroscopy time was logged from the fluoroscopy machine.
In group A, blood loss averaged 154±30.98 mL, slightly more than in group B (150±32.92 mL), though the difference was not statistically significant (p>0.05). Group A also showed a higher difference in hemoglobin levels (2.20±1.13 g/dL) compared to group B (1.15±0.93 g/dL), which was statistically significant (p=0.02). Fluoroscopy time and duration of the surgery were slightly longer in group A compared to group B but not statistically significant (p=0.693).
The suprapatellar approach results in less blood loss, potentially promoting faster recovery, reduced need for blood transfusions, and shorter hospital stays. It also entails shorter fluoroscopy time and surgical duration, though not statistically significant, which may reduce radiation exposure for the surgical team.
髓内交锁钉固定术是治疗胫骨骨折的常见外科手术，可使患者早日活动。传统上，髌下入路一直用于胫骨骨折的髓内交锁钉固定术，但髌上入路因其潜在优势而受到关注。这项随机对照研究旨在比较髌上入路和髌下入路在手术时间、术中失血量和透视时间方面的差异。
我们纳入了38例胫骨干骨折的成年患者，排除了骨不连、开放性骨折、翻修手术或格拉斯哥昏迷量表（GCS）评分低的患者。采用区组随机化将患者平均分为两组：A组（19例患者）采用髌下入路，B组（19例患者）采用髌上入路。采用重量法并通过术前和术后血红蛋白水平的变化来测量失血量。通过计算手术开始和结束之间的时间来确定手术时间，并从透视机记录透视时间。
A组平均失血量为154±30.98 mL，略多于B组（150±32.92 mL），但差异无统计学意义（p>0.05）。与B组（1.15±0.93 g/dL）相比，A组血红蛋白水平差异也更高（2.20±1.13 g/dL），具有统计学意义（p=0.02）。A组的透视时间和手术时间比B组略长，但无统计学意义（p=0.693）。
髌上入路导致的失血量更少，可能促进更快恢复、减少输血需求和缩短住院时间。它还具有更短的透视时间和手术时间，尽管无统计学意义，这可能减少手术团队的辐射暴露。
