【摘要】 目的比较髌上入路与经髌韧带入路髓内钉治疗胫骨中下段骨折的临床效果。方法选取2015年3月～2018年3月山东省东营市人民医院收治的胫骨中下段骨折100例为研究对象,按照治疗方案的不同将患者分为甲组和乙组,每组50例。甲组采用髌上入路髓内钉内固定,乙组采用经髌韧带入路髓内钉内固定。比较两组患者术后的临床效果,临床相关指标、膝关节功能及术后并发症情况。结果甲组术后12个月优良率高于乙组,差异有统计学意义(P <0.05)。甲组术中透视次数少于乙组,手术时间及术后骨折愈合时间短于乙组,术前/术后周径比值低于乙组,差异均有统计学意义(均P <0.05),而两组患者术中出血量比较,差异无统计学意义(P>0.05)。组间比较、时间点比较及交互作用差异均有统计学意义(均P <0.05)。与术后2周比较,两组患者术后6、12个月HSS评分升高,且术后12个月美国特种外科医院评分系统(HSS)评分高于术后6个月,差异均有统计学意义(均P <0.05);术后2周,两组患者HSS评分比较差异无统计学意义(P> 0.05);术后6、12个月,甲组HSS评分高于乙组,差异均有统计学意义(均P <0.05)。甲组膝前痛发生率低于乙组(P <0.05)。结论髌上入路较经髌韧带入路髓内钉治疗胫骨中下段骨折效果更好,并具有手术时间、术后骨折愈合时间较短的优点,利于恢复膝关节功能,术后膝前痛发生率更低,值得临床优先推广运用。更多还原

【Abstract】 Objective To compare the clinical effects of suprapatellar approach and transpatellar ligament approach with intramedullary nail in the treatment of middle and lower tibial fractures. Methods A total of 100 cases of middle and lower tibial fractures admitted to Dongying People′ s Hospital in Shandong Province from March 2015 to March2018 were selected as the research object. According to the different treatment plans, the patients were divided into group A and group B, with 50 cases in each group. The group A was fixed with suprapatellar approach with intramedullary nail fixation, and the group B was fixed with transpatellar ligament approach with intramedullary nail fixation. The postoperative clinical effect, clinical related indicators, knee joint function and complications were compared between the two groups. Results The excellent and good rate of the group A at 12 months after operation was higher than that of the group B, and the difference was statistically significant(P < 0.05). The times of fluoroscopy in the group A was less than that in the group B, the time of operation and fracture healing after operation was shorter than that in the group B, and the ratio of cross-section diameter of before and after operation was lower than that in the group B, with statistically significant differences(all P < 0.05). However, there was no statistically significant difference in intraoperative blood loss between the two groups(P > 0.05). There were statistically significant differences in the comparison between groups, in the comparison at time points and in the interaction between the two groups(all P <0.05). Compared with two weeks after operation, HSS scores of patients in the two groups and 6 and 12 months after operation were increased, and the special surgical hospital scoring system in the United States(HSS) scores of patients in the two groups 12 months after operation were higher than 6 months after operation, with statistically significant differences(all P < 0.05). Two weeks after the operation, there was no statistical difference in HSS score between the two groups(P > 0.05). HSS scores in the group A at 6 and 12 months after the operation were higher than those in the group B, with statistically significant differences(all P < 0.05). The incidence of anterior knee pain in the group A was lower than that in the group B(P < 0.05).Conclusion Suprapatellar approach is better than transpatellar ligament approach with intramedullary nail in the treatment of middle and lower tibial fracture. It has the advantages of shorter operation time and shorter healing time after operation. It is conducive to the recovery of knee joint function, and it has lower incidence of anterior knee pain after operation, so it is worthy of clinical application.更多还原