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对比研究

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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 March 2018 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.

Key words： Intramedullary nail Middle and lower tibial fractures Suprapatellar approach Transpatellar ligament approach Knee joint function

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	LI Dengjun1 LI Hailiang2 LIU Chenggong2 LIU Guangquan1

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LI Dengjun1 LI Hailiang2 LIU Chenggong2 LIU Guangquan1. Clinical comparative study of suprapatellar approach and transpatellar ligament approach with intramedullary nail in the treatment of middle and lower tibial fractures[J]. 中国医药导报, 2020, 17(12): 85-88,104.

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http://www.yiyaodaobao.com.cn/EN/ OR http://www.yiyaodaobao.com.cn/EN/Y2020/V17/I12/85

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