[1]喻一东,陈波涛△,杨利,等.半伸膝位经改良髌旁支持带入路置入胫骨髓内钉[J].中国中医骨伤科杂志,2018,26(12):42-45.
点击复制

半伸膝位经改良髌旁支持带入路置入胫骨髓内钉()
分享到:

《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第26卷
期数:
2018年12期
页码:
42-45
栏目:
临床报道
出版日期:
2018-12-03

文章信息/Info

文章编号:
1005-0205(2018)12-0042-04
作者:
喻一东1陈波涛1△杨利1匡军1侯文1胡昆伦1
1重庆市九龙坡区中医院(重庆,400080) 通信作者 E-mail:271114988@qq.com
关键词:
胫骨骨折 髓内钉 髌旁 入路 支持带 半伸膝位
分类号:
R683.42
文献标志码:
B
摘要:
目的:研究半伸膝位经髌旁支持带入路置入胫骨髓内钉治疗胫骨骨折,评估该治疗方法的影像学结果和临床效果。方法:选取本院骨伤科2014年9月至2017年3月因胫骨骨折需要行胫骨髓内钉的病例,采取半伸膝位经髌旁支持带入路置入胫骨髓内钉固定胫骨骨折,共39例。记录随访超过1年的结果,评价内容包括:术前术后膝关节及胫骨骨折影像学表现,复位方式,术中透视次数,感染发生率,并发症,膝痛(VAS评分),膝关节活动范围,骨折愈合情况及膝关节Lysholm评分。结果:39例患者均得到完整随访,平均随访93.6周(55~137周),7例采取切开复位,32例采取闭合复位,术中透视次数平均3.8次,无切口或骨感染,所有病例均无成角>5°者。膝关节VAS评分:术后次日平均4.3分,术后1周2.3分。3例术后12周内存在髌韧带处疼痛,髌前疼痛发生率为7.7%.术后2周膝关节屈伸活动范围平均99.3°(0°~121°),术后12周患侧膝关节屈伸活动范围平均125.3°(0°~140°),术后12周膝关节Lysholm评分平均92.8(72~97)分,优良率92.3%.无骨折不愈合,1例胫骨中上段骨折病例延迟愈合。结论:采取半伸膝位经髌旁支持带入路置入胫骨髓内钉治疗胫骨骨折,有利于术中复位、透视,胫骨力线恢复良好,髌前或胫骨结节处疼痛发生率低,更有利于膝关节早期功能锻炼和屈伸活动的恢复,值得进一步研究和推广。

参考文献/References:

[1] Xia L,Zhou J,Zhang Y,et al.A Meta-analysis of reamed versus undreamed intramedullary nailing for the treatment of closed tibial fractures [J].Orthopedics,2014,37(4):e332 -338.
[2] Zelle BA,Boni G.Safe surgical technique:intramedullary nail fixation of tibial shaft fractures[J].Patient Saf Surg,2015,9(40):1-17.
[3] Stinner DJ,Mir H.Techniques for intramedullary nailing of proximal tibia fracture[J].Orthop Clin North Am,2014,45(1):33-45.
[4] Toivanen JAK,Honkonen SE,Koivisto AM,et al.Treatment of low energy tibial shaft fractures:plaster cast compared with intramedullary nailing[J].IntOrthop,2001,25(2):110-113.
[5] 巩金鹏,聂小羊,蔡明.髌上入路髓内钉技术治疗胫骨干骨折的研究[J].同济大学学报:医学版,2016,37(3):118-122.
[6] Althausen PL,Neiman R,Finkemeier CG,et al.Incision placement for intramedullary tibial nailing:an anatomic study[J].J Orthop Trauma,2002,16(10):687-690.
[7] Morandi MD,Kyle M,Rose MS,et al.Update in tibia intramedullary nailing:percutaneous suprapatellar access route with the knee in semiextended position for intramedullary stabilization of tibia fractures[J].Techniques in Orthopaedics,2014,29(2):56-60.
[8] Beltran MJ.Collinge CA,Patzkowski JC.Intra articular risks of suprapatellar nailing[J].Am J Orthop,2012,41(12):546-550.
[9] Jakma T,Reynders FP,Rajmohan R.Insertion of intramedullary nails from the suprapatellar pouch for proximal tibial shaft fractures:a technical note[J].Acta Orthop Belg,2011,77(6):834-837.
[10] Rueger JM,Rucker AH,Hoffmann M.Suprapatellar approach to tibial medullary nailing with electromagnetic field guided distal locking[J].Der Unfallchirurg,2015,118(4):302-310.
[11] 王惠,汤健.髌上入路、经髌韧带入路髓内钉内固定治疗胫骨干骨折对比观察[J].山东医药,2015,55(35):58-59.
[12] Ryan SP,Tornetta P,Dielwart C,et al.Knee pain correlates with union after tibial nailing[J].J Orthop Trauma,2011,25(12):731-735.
[13] 王勇,李海波,陈运庆,等.胫骨干骨折髓内钉固定后病人膝关节前侧疼痛的临床观察[J].湖南师范大学学报:医学版,2015,12(2):86-88.
[14] Katsoulis E,Court-Brown C,Giannoudis PV.Incidence and aetiology of anterior knee pain after intramedullary nailing of the femur and tibia[J].J Bone Joint Surg Br,2006,88-B:576-580.
[15] Tornetta P,Collins E.Semiextended position of intramedullary nailingof the proximal tibia[J].Clin Orthop,1996,328:185-189.
[16] 解冰,杨超,田竞,等.髌上入路胫骨髓内钉治疗胫骨近端骨折[J].中国骨伤,2015,28(10):955-959.
[17] Bong MR,Koval KJ,Egol KA.The history of intramedullary nailing[J].Bull NYU Hosp Jt Dis,2006,64:94-97.
[18] Whittle AP.Fractures of the lower extremity.In:Campbell WC,Canale ST,Beaty JH,eds.Campbell's Operative Orthopaedics.Philadelphia:Mosby/Elsevier,2008.
[19] Samuelson MA,McPherson EJ,Norris L.Anatomic assessment of the proper insertion site for a tibial intramedullary nail[J].J Orthop Trauma,2002,16(1):23-25.
[20] Jones M,Parry M,Whitehouse M,et al.Radiologic outcome and patient reported function after intramedullary nailing:a comparison of the retropatellar and infrapatellar approach[J].J Orthop Trauma,2014,28(5):256-262.
[21] Eastman JG,Tseng SS,Lee MA,et al.The retropatellar portal as an alternative site for tibial nail insertion:a cadaveric study[J].J Orthop Trauma,2010,24(11):659 -664.
[22] Leary J,Werger M,Sagebien C,et al.A novel technique for percutaneous removal of a suprapatellar intramedullary nail[J].Am J Orthop,2013,42(3):136-140.
[23] Kubiak EN,Widmer BJ,Horwitz DS.Extra-articular technique for semiextendedtibial nailing[J].J Orthop Trauma,2010,24(11):704-708.

备注/Memo

备注/Memo:
基金项目:重庆市卫生计生委医学科研计划项目 (2015MSXM152)
更新日期/Last Update: 2018-12-03