摘要
目的探讨髌上入路锁定型胫骨髓内钉治疗胫骨干多节段骨折的疗效。方法回顾性分析2012年3月至2015年8月收治且获得有效随访的21例胫骨干多节段骨折患者资料，男15例，女6例：年龄26～71岁，平均46．0岁；骨折Melis分型：Ⅰ型13例，Ⅱ型4例，Ⅲ型2例，Ⅳ型2例；开放性骨折10例（Gustilo分型：I型5例，Ⅱ型2例，ⅢA型1例，ⅢB型2例）。手术全部行闭合复位内固定，选用第3代髌上入路锁定型胫骨髓内钉治疗。术后采用Lysholm评分评定膝关节功能。结果21例患者术后获10—36个月（平均17．8个月）有效随访（超过3次，时间大于术后10个月），X线片检查骨痂出现时间为2～11个月（平均7．1个月）。1例患者发生骨不连。术后无伤口感染、软组织坏死和骨髓炎发生。术后2例患者出现膝关节痛，5例患者出现踝关节痛，疼痛视觉模拟评分为2～3分，对症治疗后膝关节痛于术后5个月缓解，踝关节痛3例缓解。术后10个月膝关节Lysholm评分为87～99分，平均95分。结论经髌上入路锁定型胫骨髓内钉治疗胫骨干多节段骨折，既能有效固定涉及干骺端骨折的多端骨折，又能有效避开许多普通髓内钉应用中的不利因素，对骨折合并小腿软组织损伤者，更是一种理想、有效的治疗方法。
Objective To explore the therapeutic advantages of suprapatellar nailing for treatment of segmental tibial fractures. Methods Twenty-one tibial segmental fractures were managed and followed-up regularly in our hospital from March 2012 to August 2018. They were 15 males and 6 females, with an average age of 46.0 years （range, from 26 to 71 years）. There were 13 cases of type I , 4 cases of type ]], 2 cases of type ]1I and 2 cases of type IV, according to Melis classification. There were totally l0 open fractures （5 cases of type I, 2 cases of type ]], one case of type ]HA and 2 cases of type roB, according to Gustilo classification）. All the cases received closed reduction and internal fixation with suprapatellar locked tibial nailing of the third generation. Non-weight-bearing exercises of the knee and ankle and muscular strength training for the low ex- tremity commenced 3 days after internal fixation. The knee functions were evaluated postoperatively using the Lyshohn knee scoring. Results All the 21 cases were followed up for 10 to 36 months （average, 17.8 months; more than 3 times during at least 10 months）. X-ray revealed occurrence of the callus from 2 to 11 months （average, 7. 1 months） after operation. One case of nonunion occurred at the tibial mid-shaft. There was no wound infection, soft tissue necrosis or osteomyelitis. Two cases complained of knee pain and 5 cases of ankle pain, with VAS scores ranging from 2 to 3. After symptomatic management, the knee pain was relieved in 2 cases after 5 months and the ankle pain was relieved in 3 cases. The average Lysholm score 10 months after surgery was 95 points （range, from 87 to 99 points） . Conclusion Suprapatellar nailing is an effective treatment for segmental tibial shaft fractures, especially for those involving injuries to the metaphyseal region and peripatellar soft tissue, because it can provide effective fixation of the multiple metaphyseal fractures and avoid disadvantages of conventional intramedullary nailing, leading to limited postoperative knee pain.
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2018年第2期167-171,共5页
Chinese Journal of Orthopaedic Trauma
关键词
胫骨骨折
骨折固定术
内
骨钉
髌上入路
Tibial fractures
Fracture fixation, internal
Bone nailing
Supar-patellar approach
