侧卧位髌下髓内钉置入固定胫骨干骨折△

Intramedullary nailing via infrapatellar approach in lateral position for fixation of tibial shaft fractures

摘要:

[目的] 介绍侧卧位髌下髓内钉置入固定胫骨干骨折的手术技术和初步临床效果。[方法] 2015 年 6 月—2019 年 9 月，对 103 例胫骨干骨折患者行闭合复位内固定术。患者取侧卧位，屈膝 90°，闭合复位骨折，行髌下切口，劈髌腱，向胫骨髓腔内置入导针，扩髓。沿导针打入大小合适的髓内钉，分别置入远端和近端锁定螺钉。[结果] 所有患者均顺利完成手术，术中无血管、神经损伤等严重并发症。术中透视 (10.80±2.43) 次，导丝一次置入成功 84 例 (81.55%)，手术时间 (72.98±14.21)min。临床骨折愈合时间为(14.03±5.98)周，术后 12 个月时 LEFS 评分为(77.19±2.39)分，膝前痛 17 例，畸形愈合 5 例，无深部感染和骨不连发生。[结论]侧卧位经髌骨下入路行胫骨干骨折髓内钉内固定是一种舒适的体位，具有术中透视便捷，手术时间短等优点。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical results of intramedullary nailing via infrapatellar approach in lateral position for fixation of tibial shaft fractures. [Methods] From June 2015 to September 2019, a total of 103 patients un- derwent closed reduction and internal fixation for tibial shaft fracture. The patient was placed in lateral decubitus, and the affected knee was positioned in 90 degrees of flexion. Under axial traction, the fractures were closely reduced manually. An infrapatellar incision was made, and then the patellar tendon was split longitudinally to expose the proximal tibia. As a guide pin was inserted into the medullary cavi- ty from the proximal tibia, reaming was conducted and a main nail in proper size was inserted following the guide pin. After satisfactory frac- tures reduction and proper position verified fluoroscopically, the guide pin was removed, and interlocking screws were placed distally and proximally. [Results] All patients were successfully operated on without serious complications such as vascular and nerve injury, whereas with intraoperative fluoroscopy of (10.80±2.43) times, successful guide pin placement in the first time in 84 cases (81.55%) , operation time of (72.98±14.21) min. The patients got clinical fracture healing in (14.03±5.98) weeks, with LEFS score of (77.19±2.39) 12 months after op- eration. Of them, 17 case had anterior knee pain and 5 had malunion, whereas none of deep infection and fracture nonunion was noted at the latest follow up. [Conclusion] Intramedullary nailing via infrapatellar approach in lateral position for tibial shaft fractures is a comfort- able position with advantages of convenience to intraoperative fluoroscopy, shortening operation time and reducing number of assistants.