两种不同入路行髓内钉固定胫骨中段骨折的手术效果及膝关节功能对比
|
摘要
目的探讨髌上入路与髌下入路在髓内钉治疗胫骨中段骨折中的手术效果差异及术后膝关节功能对比。方法选取我院(2012年2月至2016年5月)采用髓内钉内固定治疗的80例胫骨中段骨折患者进行回顾性分析,其中采用髌上入路手术(上路组)和髌下入路手术(下路组)患者各40例,对比两组患者的手术时间、术中出血量、X线照射次数、骨折愈合时间、术后并发症、术后膝关节功能。结果上路组患者的手术时间、术中出血量、骨折愈合时间与下路组患者比较,差异均不具有统计学意义(P>0.05);上路组患者的X线照射次数显著的低于下路组患者(P<0.05);上路组患者的术后发生踝关节疼痛、切口感染的发生率与下路组患者比较,差异均不具有统计学意义(P>0.05);上路组患者髌前疼痛发生率低于下路组患者(P<0.05);术后4个月,上路组患者的跛行、下蹲及疼痛评分均高于下路组(P<0.05),上路组患者的支持、绞锁、不稳定、肿胀、上楼各项评分与下路组比较,差异不具有统计学意义(P>0.05)。结论胫骨中段骨折患者应用髌上入路髓内钉治疗较髌下入路具有一定的临床优势,体现在减少术中X线照射、减少术后髌前疼痛发生率、术后膝关节功能恢复更好三个方面。
Objective To compare the surgical effects and postoperative knee function between intramedullary nailing of approach above patella and intramedullary nailing of approach below patella for the treatment of middle tibia fracture. Methods 80 cases of middle tibia fracture who were treated with intramedullary nailing fixing in Dongying People's Hospital between February 2012 and May 2016 were selected for study. Among them, 40 cases who were treated with intramedullary nailing of approach above the patella consisted of an observation group while the remaining 40 cases who were treated with intramedullary nailing of approach below the patella consisted of a control group. Then the patients in the two groups were compared in the aspects of operation duration, intraoperative blood loss, number of X-ray irradiation, fracture healing time, postoperative complications, and postoperative knee function. Results Firstly, the operation duration, intraoperative blood loss, fracture healing time of the patients in the observation group were not significantly different from those in the control group(P>0.05). Secondly, the number of X-ray irradiation in the observation group was significantly lower than that of the control group(P<0.05). Thirdly, the incidences of ankle pain and incision infection of the patients in the observation group were not significantly different from those in the control group(P>0.05). Fourthly, the incidence of prepatellar pain of the patients in the observation group was lower than that in the control group(P<0.05). Fifthly, the scores of claudication, squat and pain after four months of surgery in the observation group was lower than those in the control group(P<0.05). Sixthly, there was no significant difference in scores of the support, locking, instability, swelling, and the upstairs climbing between the two groups(P>0.05). Conclusion Compared with intramedullary nailing of approach below patella, intramedullary nailing of approach above patella has certain clinical advantages in the treatment of middle tibia fracture, including the reduction of times of intraoperative X-ray irradiation, reduction of postoperative incidence of prepatellar pain, and the quick recovery of postoperative knee function.
Objective To compare the surgical effects and postoperative knee function between intramedullary nailing of approach above patella and intramedullary nailing of approach below patella for the treatment of middle tibia fracture. Methods 80 cases of middle tibia fracture who were treated with intramedullary nailing fixing in Dongying People's Hospital between February 2012 and May 2016 were selected for study. Among them, 40 cases who were treated with intramedullary nailing of approach above the patella consisted of an observation group while the remaining 40 cases who were treated with intramedullary nailing of approach below the patella consisted of a control group. Then the patients in the two groups were compared in the aspects of operation duration, intraoperative blood loss, number of X-ray irradiation, fracture healing time, postoperative complications, and postoperative knee function. Results Firstly, the operation duration, intraoperative blood loss, fracture healing time of the patients in the observation group were not significantly different from those in the control group(P>0.05). Secondly, the number of X-ray irradiation in the observation group was significantly lower than that of the control group(P<0.05). Thirdly, the incidences of ankle pain and incision infection of the patients in the observation group were not significantly different from those in the control group(P>0.05). Fourthly, the incidence of prepatellar pain of the patients in the observation group was lower than that in the control group(P<0.05). Fifthly, the scores of claudication, squat and pain after four months of surgery in the observation group was lower than those in the control group(P<0.05). Sixthly, there was no significant difference in scores of the support, locking, instability, swelling, and the upstairs climbing between the two groups(P>0.05). Conclusion Compared with intramedullary nailing of approach below patella, intramedullary nailing of approach above patella has certain clinical advantages in the treatment of middle tibia fracture, including the reduction of times of intraoperative X-ray irradiation, reduction of postoperative incidence of prepatellar pain, and the quick recovery of postoperative knee function.
引文
[1]张志新,周君东,陈兴阳,等.锁定加压接骨板结合微创经皮钢板内固定技术与交锁髓内钉治疗老年性胫骨中下段骨折[J].中国组织工程研究,2017,21(15):2378-2382.
[2]马腾,王谦,路遥,等.闭合复位髓内钉固定胫骨骨折术中远端是否存在内外翻的判断[J].中华创伤骨科杂志,2016,18(7):553-557.
[3]王喆,李盛龙,王晓雨,等.髌上入路与髌下入路髓内钉固定治疗胫骨干骨折的疗效比较[J].中华创伤骨科杂志,2016,18(4):283-289.
[4]Abdelhaq M M,Kamal A M,Elramely M A.Different Volumes of Local Anesthetics in Ultrasound-Guided Combined Interscalene-Supraclavicular Block for Traumatic Humera Fracture[J].Open Journal of Anesthesiology,2016,6(4):55-62.
[5]张晶,马江卫.磁力导航META-NAIL锁定型胫骨髓内钉髌上入路治疗胫骨干骨折的优势[J].中国组织工程研究,2017,21(27):4336-4341.
[6]林斌,陈志达,吴进,等.自行研制的胫骨可调负重支具在AO分型42-B型胫骨干骨折髓内钉固定术后的应用[J].中华创伤骨科杂志,2017,19(1):47-53.
[7]陈德明,徐晓阳,王蔚,等.多功能带锁髓内钉和钢板置入内固定修复关节外胫骨创伤性骨折[J].中国组织工程研究,2016,20(4):549-553.
[8]Ali Y,Roozbeh T,Mehdi M.Comparing the Intramedullary Nailing Method Versus Dynamic Hip Screw in Treatment of Unstable Intertrochanteric Fractures:[J].Medica Archives,2016,70(1):53-56.
[9]侯靖钊,张秋林,包洪卫,等.髓内钉结合阻挡螺钉修复胫骨远段骨折[J].中国组织工程研究,2016,20(31):4616-4622.
[10]陈昌博,鲁道海.经皮锁定加压钢板固定与交锁髓内钉固定治疗胫骨远端关节外骨折效果对比观察[J].山东医药,2016,56(44):86-88.
[11]Sutphen S A,Mendoza J D,Mundy A C,et al.Pediatric Diaphyseal Femur Fractures:Submuscular Plating Compared With Intramedullary Nailing.[J].Orthopedics,2016,39(6):1.
[12]郭志民,龚星星,王瑛,等.交锁髓内钉内固定治疗胫骨多节段骨折的疗效[J].中华创伤杂志,2017,33(2):171-174.
[13]艾自胜,于淼,梅炯,等.髓内钉与外固定治疗胫腓骨骨折疗效的Meta分析[J].中国矫形外科杂志,2017,25(8):714-719.
[2]马腾,王谦,路遥,等.闭合复位髓内钉固定胫骨骨折术中远端是否存在内外翻的判断[J].中华创伤骨科杂志,2016,18(7):553-557.
[3]王喆,李盛龙,王晓雨,等.髌上入路与髌下入路髓内钉固定治疗胫骨干骨折的疗效比较[J].中华创伤骨科杂志,2016,18(4):283-289.
[4]Abdelhaq M M,Kamal A M,Elramely M A.Different Volumes of Local Anesthetics in Ultrasound-Guided Combined Interscalene-Supraclavicular Block for Traumatic Humera Fracture[J].Open Journal of Anesthesiology,2016,6(4):55-62.
[5]张晶,马江卫.磁力导航META-NAIL锁定型胫骨髓内钉髌上入路治疗胫骨干骨折的优势[J].中国组织工程研究,2017,21(27):4336-4341.
[6]林斌,陈志达,吴进,等.自行研制的胫骨可调负重支具在AO分型42-B型胫骨干骨折髓内钉固定术后的应用[J].中华创伤骨科杂志,2017,19(1):47-53.
[7]陈德明,徐晓阳,王蔚,等.多功能带锁髓内钉和钢板置入内固定修复关节外胫骨创伤性骨折[J].中国组织工程研究,2016,20(4):549-553.
[8]Ali Y,Roozbeh T,Mehdi M.Comparing the Intramedullary Nailing Method Versus Dynamic Hip Screw in Treatment of Unstable Intertrochanteric Fractures:[J].Medica Archives,2016,70(1):53-56.
[9]侯靖钊,张秋林,包洪卫,等.髓内钉结合阻挡螺钉修复胫骨远段骨折[J].中国组织工程研究,2016,20(31):4616-4622.
[10]陈昌博,鲁道海.经皮锁定加压钢板固定与交锁髓内钉固定治疗胫骨远端关节外骨折效果对比观察[J].山东医药,2016,56(44):86-88.
[11]Sutphen S A,Mendoza J D,Mundy A C,et al.Pediatric Diaphyseal Femur Fractures:Submuscular Plating Compared With Intramedullary Nailing.[J].Orthopedics,2016,39(6):1.
[12]郭志民,龚星星,王瑛,等.交锁髓内钉内固定治疗胫骨多节段骨折的疗效[J].中华创伤杂志,2017,33(2):171-174.
[13]艾自胜,于淼,梅炯,等.髓内钉与外固定治疗胫腓骨骨折疗效的Meta分析[J].中国矫形外科杂志,2017,25(8):714-719.