摘要
目的比较髌上入路与传统髌下入路髓内钉技术治疗胫骨干骨折的临床疗效。方法回顾性分析2013年3月至2015年3月本院收治采用髓内钉技术治疗的79例胫骨干骨折患者的病例资料。髌上入路41例（A组）,男26例,女15例,年龄（41.54±10.52）岁。传统髌下入路38例（B组）,男22例,女16例,年龄（39.47±8.20）岁。全部患者为单侧下肢骨折,行闭合复位内固定治疗。比较两组的手术时间、术中出血量、住院时间、骨折愈合时间、术后膝关节功能评分、临床优良率、术后膝前疼痛发生率等情况。结果所有手术顺利完成,术后随访6～24个月,平均14.7个月。参照Johner-Wruh评分标准,A、B两组术后第24周临床优良率分别为95.1%和79.0%,Lysholm平均评分分别为92.2分和87.7分,功能评分及膝前疼痛发生率方面差异有显著性意义（P〈0.05）。结论髌上入路可以避免切开髌腱等组织,减少膝前疼痛率,利于患者早期进行功能锻炼,提高临床效果,值得在临床上推荐。
Objective To compare the efficacy of interlocking intramedullary nailing for tibial fracture via supra-patellar approach with subpatellar approach.Methods Seventy nine patients with tibial metaphyseal fractures treated by closed reduction and interlocking intramedullary nail fixation from M arch 2013 to M arch 2015,including 41 cases treated through supra-patellar approach（group A）,and 38 cases treated through conventional subpatellar approach（group B）.The operation time,intraoperative blood loss,length of hospital stay,healing time of fracture,knee function,excellent and good outcome rate,and anterior knee pain were compared between two groups.Results All operations were completed successfully.Patients were followed up for average 14.7 months（6-24months）.At 24 th week after operation,according to Johner-Wruh scale,the excellent and good rate of groups A and B was 95.1% and 79.0%（P〈0.05）;the Lysholm scores of two groups were 92.2 and87.7（P〈0.05）.The excellent and good rate of knee function in group A was higher than that in group B,and the anterior knee pain was improved more markedly in group A than that in group B（P〈0.05）.Conclusion Compared with conventional sub-patellar approach,supra-patellar approach has better clinical outcome and earlier postoperative mobilization for patients with tibial fracture receiving interlocking inremedullary nail fixation.
出处
《同济大学学报（医学版）》
CAS
2016年第3期118-122,共5页
Journal of Tongji University(Medical Science)
基金
上海市自然科学基金(14ZR1432600)
关键词
胫骨骨折
髓内钉固定术
髌上入路
tibial fractures
Interlocking intramedullary nailing
supra-patellar approach
