摘要
目的探讨不同入路髓内钉固定对胫骨骨折患者术后生物力学稳定效果及早期负重的影响,以提高骨折治疗的效果和患者的康复进程。方法回顾性分析2018年6月~2024年3月医院收治的胫骨骨折患者86例,对照组采用经髌下入路髓内钉固定治疗,观察组采用经髌上入路髓内钉固定治疗。比较两组术中情况、术后愈合、膝关节运动稳定性及屈曲活动度、血液流变学指标及术后并发症。以术后4周内负重做为早期负重,术后4周后负重做为晚期负重,比较不同负重组患者的膝关节功能恢复情况。结果观察组术中透视次数少于对照组(P<0.05)。观察组骨折正常愈合率为88.64%,高于对照组(P<0.05)。术后3、6个月,观察组Lysholm评分、HSS评分、屈曲活动度均高于对照组(P<0.05)。术后,两组血浆黏度、红细胞压积、红细胞沉降率下降(P<0.05),观察组低于对照组(P<0.05)。86例胫骨骨折患者中,早期负重52例,晚期负重34例。术后3、6个月,早期负重组Lysholm评分、HSS评分及屈曲活动度高于晚期负重组(P<0.05)。结论经髌上入路髓内钉固定治疗胫骨骨折,有助于促进患者术后下肢运动功能的恢复,且术后早期负重有助于促进膝关节功能恢复。
Objective To explore the effects of different intramedullary nail fixation approaches on postoperative biomechanical stability and early weight-bearing in tibial fracture patients,with the aim of improving fracture treatment efficacy and patients’rehabilitation processes.Methods A retrospective analysis was conducted on the medical records of 86 patients with tibial fractures admitted to the hospital from June 2018 to March 2024.The control group received intramedullary nail fixation through the infrapatellar approach,while the observation group received intramedullary nail fixation through the suprapatellar approach.The intraoperative conditions,postoperative healing,knee joint stability and flexion range of motion,hemorheology,and postoperative complications between two groups were compared.The recovery of knee joint function among patients in different weight-bearing groups was compared,with early weight-bearing recorded within 4 weeks after surgery and late weight-bearing recorded 4 weeks after surgery.Results The observation group had fewer intraoperative fluoroscopy sessions than the control group(P<0.05).The normal healing rate of fractures in the observation group was 88.64%,which was higher than that in control group(P<0.05).At 3^(rd) and 6^(th) months after surgery,the Lysholm score,HSS score,and flexion range of motion in the observation group were higher than those in control group.After surgery,plasma viscosity,hematocrit,and erythrocyte sedimentation rate decreased in both groups(P<0.05),and the above indices of observation group were lower than those of control group(P<0.05).Among 86 patients with tibial fractures,52 had early weight-bearing and 34 had late weight-bearing.At 3^(rd) and 6^(th) months after surgery,the Lysholm score,HSS score,and flexion range of motion of early weight-bearing group were higher than those of late weight-bearing group(P<0.05).Conclusions The treatment of tibial fractures with intramedullary nail fixation through the anterior patellar approach can help promote the recovery of lower limb motor function in patients after surgery,and early postoperative weight-bearing can help promote the recovery of knee joint function.
作者
张大伟
陈鸣
韩琪
ZHANG Dawei;CHEN Ming;HAN Qi(Trauma Center,Lianyungang Second People’s Hospital(Lianyungang Cancer Hospital),Lianyungang 222100,Jiangsu,China)
出处
《医用生物力学》
北大核心
2025年第6期1488-1493,共6页
Journal of Medical Biomechanics
基金
江苏省自然科学基金项目(BK20221288)。
关键词
胫骨骨折
髓内钉固定
入路方式
下肢运动功能
早期负重
tibial fracture
intramedullary nail fixation
access method
lower limb motor function
early loading
