半伸直位髌旁外侧入路胫骨髓内钉治疗胫骨骨折的效果
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摘要
目的探讨膝关节半伸直位髌旁外侧入路胫骨髓内钉治疗胫骨骨折的临床效果。方法选择我院收治的胫骨骨折患者17例,均采用半伸直位髌旁外侧入路胫骨髓内钉治疗。记录患者的手术时间、骨折愈合时间和术后Lysholm膝关节评分以评定手术疗效。结果 17例患者手术时间45~75 min,平均(52.13±4.06)min。所有患者获得7~15个月的随访。随访期间患者无感染、无皮肤坏死。骨折愈合平均时间(4.21±2.61)个月。术后3个月患侧膝关节屈伸平均范围(125.36°±3.21°);随访12个月的Lysholm膝关节功能评分76~90分,平均(86.92±1.53)分。结论采用膝关节半伸直位髌旁外侧入路胫骨髓内钉技术治疗胫骨骨折是一种实用、有效的手术方法,操作相对简单,术后并发症少。
Objective To explore the clinical effect of extension lateral patellar approach intramedullary nailing in the treatment of tibial fractures. Methods A total of 17 cases of tibial fractures were selected and all treated with extension lateral patellar approach intramedullary nailing. The operation time, fracture healing time and postoperative Lysholm knee joint score were recorded to evaluate the curative effect. Results The operative time of 17 patients was 45-75 min, with an average of(52.13±4.06) min. All patients were followed up for 7-15 months. During the follow-up period, no infection, no skin necrosis occurred. The average healing time of fracture was(4.21±2.61) months. At 3 months after operation, the flexion extension average range of the affected side was(125.36°±3.21°); and at 12 months of follow-up, the Lysholm knee function score was 76-90 points, with an average of(86.92 ±1.53) points. Conclusion The extension lateral patellar approach intramedullary nailing in the treatment of tibial fracture is a very practical and effective surgical approach, it is a relatively simple operation and with less postoperative complications.
Objective To explore the clinical effect of extension lateral patellar approach intramedullary nailing in the treatment of tibial fractures. Methods A total of 17 cases of tibial fractures were selected and all treated with extension lateral patellar approach intramedullary nailing. The operation time, fracture healing time and postoperative Lysholm knee joint score were recorded to evaluate the curative effect. Results The operative time of 17 patients was 45-75 min, with an average of(52.13±4.06) min. All patients were followed up for 7-15 months. During the follow-up period, no infection, no skin necrosis occurred. The average healing time of fracture was(4.21±2.61) months. At 3 months after operation, the flexion extension average range of the affected side was(125.36°±3.21°); and at 12 months of follow-up, the Lysholm knee function score was 76-90 points, with an average of(86.92 ±1.53) points. Conclusion The extension lateral patellar approach intramedullary nailing in the treatment of tibial fracture is a very practical and effective surgical approach, it is a relatively simple operation and with less postoperative complications.
引文
[1]王惠,汤健.髌上入路、经髌韧带入路髓内钉内固定治疗胫骨干骨折对比观察[J].山东医药,2015,55(35):58-60.
[2]ROTHBERG DL,HOLT DC,HORWITZ DS,et al.Tibial nailing with the knee semi-extended:review of techniques and indications:AAOS exhibit selection[J].J Bone Joint Surg Am,2013,95(16):e116(1-8).
[3]巩金鹏,聂小羊,蔡明.髌上入路髓内钉技术治疗胫骨干骨折的研究[J].同济大学学报:医学版,2016,37(3):118-122.
[4]郝振东,李建军,胡振宇,等.胫骨干骨折采用髌上、髌下入路髓内钉治疗的疗效对比[J].实用骨科杂志,2017,23(9):794-797.
[5]XIA L,ZHOU J,ZHANG Y,et al.A meta-analysis of reamed versus unreamed intramedullary nailing for the treatment of closed tibial fractures[J].Orthopedics,2014,37(4):e332-e338.
[6]LIPORACE FA,STADLER CM,YOON RS.Problems,tricks,and pearls in intramedullary nailing of proximal third tibial fractures[J].J Orthop Trauma,2013,27(1):56-62.
[7]KUBIAK EN,WIDMER BJ,HORWITZ DS.Extra-articular technique for semiextended tibial nailing[J].J Orthop Trauma,2010,24(11):704-708.
[8]候力强,冷燕奎,王浩敏,等.半伸膝位入路改良髓内钉进钉点用于胫骨干骨折8例[J].中国乡村医药,2016,7(23):11-12.
[9]李国强,李任增,张永飞,等.外侧髌旁切口膝关节半伸直关节外髓内钉技术治疗胫骨干骨折临床疗效分析[J].创伤外科杂志,2016,18(2):103-104.
[10]SANDERS RW,DIPASQUALE TG,JORDAN CJ,et al.Semiextended intramedullary nailing of the ttibia using a suprapatellar approach:radiographic results and clinical outcomes at a minimum of 12months follow-up[J].J Orthop Trauma,2014,28(5):245-255.
[11]LELIVELD MS,VERHOFSTAD MH.Injury to the infrapatellar branch of the saphenous nerve,a possible cause for anterior knee pain after tibial nailing[J].Injury,2012,43(6):779-783.
[12]TAHRIRIAN MA,ZIAEI E,OSANLOO R.Signficance of the position of the proximal tip of the tibial nail:an important factortant factor related to anterior knee pain[J].Adv Biomed Res,2014,28(3):119.
[13]TORNETTA P 3RD,COLLINS E.Semiextended position for intramedullary nailing of the proximal tibia[J].Clin Orthop Relat Res,1996(328):185-189.
[2]ROTHBERG DL,HOLT DC,HORWITZ DS,et al.Tibial nailing with the knee semi-extended:review of techniques and indications:AAOS exhibit selection[J].J Bone Joint Surg Am,2013,95(16):e116(1-8).
[3]巩金鹏,聂小羊,蔡明.髌上入路髓内钉技术治疗胫骨干骨折的研究[J].同济大学学报:医学版,2016,37(3):118-122.
[4]郝振东,李建军,胡振宇,等.胫骨干骨折采用髌上、髌下入路髓内钉治疗的疗效对比[J].实用骨科杂志,2017,23(9):794-797.
[5]XIA L,ZHOU J,ZHANG Y,et al.A meta-analysis of reamed versus unreamed intramedullary nailing for the treatment of closed tibial fractures[J].Orthopedics,2014,37(4):e332-e338.
[6]LIPORACE FA,STADLER CM,YOON RS.Problems,tricks,and pearls in intramedullary nailing of proximal third tibial fractures[J].J Orthop Trauma,2013,27(1):56-62.
[7]KUBIAK EN,WIDMER BJ,HORWITZ DS.Extra-articular technique for semiextended tibial nailing[J].J Orthop Trauma,2010,24(11):704-708.
[8]候力强,冷燕奎,王浩敏,等.半伸膝位入路改良髓内钉进钉点用于胫骨干骨折8例[J].中国乡村医药,2016,7(23):11-12.
[9]李国强,李任增,张永飞,等.外侧髌旁切口膝关节半伸直关节外髓内钉技术治疗胫骨干骨折临床疗效分析[J].创伤外科杂志,2016,18(2):103-104.
[10]SANDERS RW,DIPASQUALE TG,JORDAN CJ,et al.Semiextended intramedullary nailing of the ttibia using a suprapatellar approach:radiographic results and clinical outcomes at a minimum of 12months follow-up[J].J Orthop Trauma,2014,28(5):245-255.
[11]LELIVELD MS,VERHOFSTAD MH.Injury to the infrapatellar branch of the saphenous nerve,a possible cause for anterior knee pain after tibial nailing[J].Injury,2012,43(6):779-783.
[12]TAHRIRIAN MA,ZIAEI E,OSANLOO R.Signficance of the position of the proximal tip of the tibial nail:an important factortant factor related to anterior knee pain[J].Adv Biomed Res,2014,28(3):119.
[13]TORNETTA P 3RD,COLLINS E.Semiextended position for intramedullary nailing of the proximal tibia[J].Clin Orthop Relat Res,1996(328):185-189.