外侧髌旁切口膝关节半伸直位关节外髓内钉技术治疗胫骨干骨折的临床疗效分析

摘要

Objective To discuss the clinical effect of lateral parapatellar incision in half straight position with intramedullary nail in the treatment of tibial shaft fractures .Methods Twenty-four cases (15 males,9 females, aged 17-63 years,average 40 years) of tibial shaft fractures were treated in our hospital from Jun .2012 to Sep.2013.Fractures of upper 1/4 tibia occurred in 17 cases,tibial fracture combined with patellar soft tissue contusion in 7 ca-ses.All cases were suited for the fixation of intramedullary nail .All the 24 cases were treated by lateral parapatel-lar incision in half straight position with intramedullary nail and followed up for more than 12 months.During the follow-up period,the visual analogue scale (VAS),activity score and disability score were used to evaluate the de-gree of anterior knee pain ,and the degree of activity of the joints .Results Incisions in the 7 patients with tibial shaft fracture combined with patellar soft tissue contusion recovered well .Of the 24 patients,80.16%patients suf-fered anterior knee pain in the follow-up of 3 to 6 weeks after operation .But after 3 months of operation ,follow-ups showed that knee pain in 79.6%of these patients disappeared and knee flexion and activity were satisfied .Accord-ing to VAS and activity score ,15 cases were excellent ,7 cases were good ,2 cases were poor .The total excellent and good rate was 91.66%.There was no obvious difference in age .Conclusion Lateral parapatellar incision in half straight position with intramedullary nail in the treatment of tibial shaft fractures ,especially for cases combined with skin and soft tissue contusion ,can greatly reduce the risk of wound infection and skin necrosis .Besides,the reduc-tion process is simple with obvious advantages of X-ray imaging.The incidence of anterior knee pain of knee joint is low and the recovery of joint function is good , especially for patients with tibial shaft fractures and tibial shaft frac-tures combined with soft tissue contusion in the anterior tibial skin .%目的：探讨分析外侧髌旁切口膝关节半伸直位关节外髓内钉技术治疗胫骨干骨折的临床疗效。方法笔者回顾性分析2012年6月～2013年9月收治的胫骨干骨折患者24例，男性15例，女性9例；年龄17～63岁，平均40岁。其中胫骨上1／4骨折17例，胫骨干骨折合并髌骨前皮肤软组织挫伤7例；均符合髓内钉固定治疗。24例患者均采取经外侧髌腱旁入路，关节外髓内钉植入技术，并得到了12个月以上的随访。随访期间，采用视觉模拟评分法（ VAS），客观的活动度评分和功能障碍评分来反映膝前痛程度、关节的活动度。结果7例胫骨干骨折合并髌骨前皮肤软组织挫伤的患者由于采用了髌旁外侧切口，切口均良好愈合。所有24例患者在术后3～6周的随访期间，80.16％的患者有膝前疼痛；但术后3个月的随访显示79.6％的患者膝前疼痛均消失，膝关节的屈伸功能及活动度均较满意。根据VAS评分及活动度评分，优15例，良7例，差2例，总优良率为91.66％。各年龄阶段无明显差异。结论外侧髌旁切口膝关节半伸直位关节外髓内钉技术，尤其对于合并髌骨前皮肤软组织挫伤者，可以大大减少切口感染及皮肤坏死的概率，而且手术复位操作简便，影像学透视优势明显。术后膝关节膝前痛的发生率低，关节功能恢复良好，尤其适用于胫骨上1／4骨折及胫骨干骨折合并髌骨前皮肤软组织挫伤的患者。