刘洋

[摘要] 目的 分析胫骨干骨折实施不同入路髓内钉固定治疗的临床效果。 方法 整群选取该院于2015年2—12月期间收治的胫骨干骨折患者56例，将其随机分为两个组别，均行髓内钉固定手术，其中对照组（经髌韧带入路）、试验组（髌上入路）各28例。观察临床疗效，比较膝关节功能和术后疼痛情况。 结果 两组在手术时间、术中出血量、骨折愈合时间上对比差异无统计学意义（P>0.05）。试验组膝关节功能优良27例（96.4%）；高于对照组22例（78.6%）；且患者术后膝关节未发生疼痛比例（85.7%）高于对照组（60.7%）。差异有统计学意义（P<0.05）。 结论 对于胫骨干骨折患者而言，髓内钉固定手术采用髌上入路、经髌韧带入路均有良好的效果，其中前者能够改善膝关节功能，减轻术后疼痛程度，值得优先选用。

[关键词] 胫骨干骨折；髓内钉固定；膝关节功能；疼痛程度

[中图分类号] R687 [文献标识码] A [文章编号] 1674-0742（2016）02（c）-0004-03

Clinical Effect of Intramedullary Nailing via Suprapatellar Versus Transpatellar Tendon Approach in the Treatment of Tibial Shaft Fracture

LIU Yang

First Department of Orthopedics， Dalian Branch， Shengjing Hospital of China Medical University， Dalian， Liaoning Province， 116600 China

[Abstract] Objective To analyze the clinical effect of intramedullary nailing via different approaches in the treatment of tibial shaft fractures. Methods 56 cases with tibial shaft fractures admitted in our hospital from February to December 2015 were selected and randomly divided into two groups， the control group and the experimental group with 28 cases in each. Patients in the control group were treated by intramedullary nailing via transpatellar tendon approach， while those in the experimental group were treated by intramedullary nailing via suprapatellar approach. The clinical efficacy was observed in both groups. And the knee joint function and degree of postoperative pain of the groups were compared. Results There were no statistically significant differences in the duration of procedure， intraoperative blood loss， and fracture healing time between the two groups （P>0.05）. The number of patients with good and excellent knee joint function was more in the experimental group than that in the control group [27 cases （96.4%） vs 22 cases （78.6%）] with statistically significant difference between the two groups （P<0.05）. The proportion of patients without postoperative knee joint pain was much higher in the experimental group than that in the control group （85.7% vs 60.7%）， the difference was statistically significant （P<0.05）. Conclusion Intramedullary nailing via either suprapatellar approach or transpatellar tendon approach can achieve good treatment effect in the treatment of tibial shaft fracture patients， but the former treatment is worthy of preferable selection for it can improve the knee joint function and reduce the degree of postoperative pain.

[Key words] Tibial shaft fracture； Intramedullary nailing； Knee joint function； Degree of pain

胫骨干骨折属于常见的四肢骨折类型，数据调查显示近年来发病率持续提升，和交通行业、各类工业的迅速发展具有密切联系。手术治疗使用髓内钉固定疗效确切，但患者术后容易出现膝关节疼痛的并发症，尽管发生原因尚未明确，但部分学者认为和手术入路的选择相关[1]。为此，该文整群选取该院2015年2—12月收治的56例患者进行分析，探讨了经髌韧带入路和髌上入路的临床效果，现报道如下。

1 资料与方法

1.1 一般资料

整群选取该院就诊的胫骨干骨折患者56例，纳入时间段为2015年2—12月，将其随机分为对照组和试验组，每组28例。在对照组中，男性15例（53.6%），女性13例（46.6%）；年龄20～64岁，平均（41.5±1.8）岁；致伤原因：车祸伤15例、坠落伤6例、砸伤5例，其它2例。在试验组中，男性17例（60.7%），女性11例（39.3%）；年龄22～66岁，平均（43.0±2.3）岁；致伤原因：车祸伤16例、坠落伤6例、砸伤3例，其它3例。两组……