Clinical Efficacy Of Intramedullary Nail In The Treatment Of Tibial Fracture Through Suprapatellar Approach And Subpatellar Approach

Objective This clinical study retrospectively compared the efficacy of suprapatellar approach and Subpatellar approach in the treatment of tibial fractures with interlocking intramedullary nails to analyze the incidence of complications after suprapatellar intramedullary nailing,and to provide basis for clinical diagnosis and treatment,so as to explore the advantages of suprapatellar approach over infrapatellar approach.Methods A retrospective study of 60 cases of closed tibial fractures treated with closed reduction and interlocking intramedullary nail in NanJing First Hospital from October 2016 to December 2018,There were 33 males and 27 females aged 18-55 years.The patients were divided into two groups according to different approaches:Subpatellar approach group(29 cases)and suprapatellar approach group(31 cases).The operation time,intraoperative bleeding volume,intraoperative fluoroscopy times,healing time of clinical fracture,Johner-wruhs score of tibial fractures efficacy,incidence of knee pain and VAS score were observed and compared.The two approaches were evaluated and compared comprehensively to determine the curative effect.Results In the comparison of intraoperative bleeding volume,the amount of bleeding in the subpatellar approach group was(119.48±26.36)mL;the amount of bleeding in the suprapatellar approach group was(113.23±30.29)mL,and there was no significant difference between the two groups(P>0.05);in the comparison of operation time,the operation time of the Subpatellar approach was(87.21±13.78)min,and the operation time of the suprapatellar approach was(81.58±13.20)min.There was no significant difference between the two groups.(P>0.05);in the comparison of fluoroscopy times during operation,the Subpatellar approach group was(31.00±6.98)times;the suprapatellar approach group was(20.23±5.63)times;the number of times between the two groups had statistical significance(P<0.05);in the clinical healing of fracture,2 cases had delayed union,dynamic treatment,and all achieved bone union after 3 months.In the Subpatellar approach group,28 cases had stage I bone union,1 case had delayed union,the healing rate of stage I was 96.5%,and the healing time of clinical fracture was(82.90±5.12)days.In the suprapatellar approach group,30 cases had stage I bone union,1 case had delayed union,the healing rate of stage I was 96.7%,and the healing time of clinical fracture was(82.23±4.91)days.There was no significant difference in clinical healing rate and healing time between the two groups(P>0.05).In Johner-Wuchs score evaluation,the excellent and good rate of Subpatellar approach group was 93.1%,and that of suprapatellar approach group was 93.5%.There was no significant difference between the two groups(P>0.05).The incidence of anterior knee pain was 37.9%in the Subpatellar approach group and 19.3%in the suprapatellar approach group.There was a significant difference in the incidence of anterior knee pain between the two groups(P<0.05).In the two groups of patients with anterior knee pain,the VAS score of Subpatellar approach group was(3.6±0.80),and that of suprapatellar approach group was(3.8±0.75).There was no significant difference between the two groups(P>0.05).Conclusion Suprapatellar approach and Subpatellar approach intramedullary nailing have good effect in clinical healing of tibial fractures.However,the suprapatellar approach avoids the damage to the peripatellar tissue and significantly reduces the occurrence of knee pain.It is of great significance for the rehabilitation and exercise of patients after operation.Suprapatellar intramedullary nail enlarges the indication of tibial intramedullary nail and has certain advantages in the treatment of tibial fractures.