【摘要】 目的 探究不同入路胫骨髓内钉内固定治疗胫骨干骨折的疗效。方法 将2019年2月～2021年7月本院收治94例胫骨干骨折患者，随机分为观察组和对照组，每组各47例。两组均实施胫骨髓内钉内固定术，观察组予以髌上入路，对照组予以髌下入路。对比两组手术指标、并发症情况、手术前后炎症免疫指标[高迁徙率族蛋白(HMGB-1)、单核细胞趋化蛋白(MCP-1)、T淋巴细胞(CD4~+、CD8~+)]、膝关节功能(HSS)、疼痛程度(VAS)及关节活动情况。结果 观察组术中X线使用次数、手术时间、住院时间优于对照组，差异均有统计学意义(P<0.05);两组并发症总发生率比较差异无统计学意义(P>0.05);观察组术后3 d CD4~+、HMGB-1、MCP-1、CD8+优于对照组，差异有统计学意义(P<0.05);观察组术后1、3个月HSS评分、VAS评分优于对照组，差异有统计学意义(P<0.05);观察组术后6个月关节活动优良率93.48%,高于对照组(77.27%),差异有统计学意义(P<0.05)。结论 两组入路实施胫骨髓内钉内固定安全可靠，但髌上入路能优化手术情况，减轻免疫功能抑制，缓解疼痛，改善患者膝关节功能。更多还原

【Abstract】 Objective To explore the efficacy of different approaches for tibial intramedullary nail fixation in the treatment of tibial shaft fractures. Methods A total of 94 patients with tibial shaft fractures in our hospital from February 2019 to July 2021 were randomly divided into two groups, with 47 cases in each group. The two groups underwent tibial intramedullary nailing and internal fixation, the observation group was given the suprapatellar approach, and the control group was given the infrapatellar approach. Comparison of surgical indicators, complications, and inflammatory and immune indicators before and after surgery [High mobility group protein box-1(HMGB-1), Monocyte chemotactic protein-1(MCP-1), T lymphocytes(CD4~+, CD8~+)], knee function(Hospital for special surgery knee score, HSS), pain level(Visual analogue score, VAS) and joint activity. Results The frequency of X-ray use, operation time and hospital stay in the observation group were better than those in the control group, the difference was statistically significant(P<0.05); there was no significant difference in the total incidence of complications between the two groups(P>0.05). The CD4+, HMGB-1, MCP-1 and CD8+ in the observation group were better than those in the control group 3 days after operation,the difference was statistically significant(P<0.05); the HSS score and VAS score of the observation group were better than those of the control group at 1 and 3 months after operation, the difference was statistically significant(P<0.05); the excellent and good rate of joint activity in the observation group was 93.48% higher than 77.27% in the control group 6 months after the operation, and the difference was statistically significant(P<0.05). Conclusion Tibial intramedullary nail fixation is safe and reliable in the two groups, however, the suprapatellar approach can optimize the operation, relieve immunosuppression, relieve pain, and improve knee joint function.更多还原