| Background: The treatment of proximal tibial intramedullary nail fracture successful angular deformity problems Tornetta 1996 and Collins invented a new approach, in knee extension position half, cut the knee capsule, initially on both sides of the patella patellar insertion into the road next to the nail, as the improved operation of one of the patellar incision approach has the advantage of avoiding excessive separation of adjacent soft tissues of the patellar tendon. Opponents argue that the point of the needle increases the pressure between the patellofemoral joint, the patellofemoral joint surface damage caused by patellofemoral arthritis and postoperative patellar pain problems. But on the road under the patella and patellar lack of adequate statistical analysis of the efficacy difference approach.Objective: To compare intramedullary nail fixation of tibial fractures on the clinical efficacy of patellar approach under way and patellar comparisons.Methods: 42 cases of tibial fractures were in the First Affiliated Hospital of Dalian Medical University from September 2012 to September 2014 were treated tibial intramedullary nail treatment applications, 24 males and 18 females; age 18-50 years,mean( 33.7 ± 7.7) years. Fresh fractures in 40 cases, two cases of old fracture. Fracture type: According to Muller’s taxonomy A0: 42A1 8 cases, 42A2 22 cases, 42B1 7 cases,42B2 type cases, 42C1 type 1 cases. Two groups of gender, age, fracture site, the type of fracture was no significant difference(P> O.05), comparable. Divided into two groups of cases fixed on the road patellar intramedullary nail was used in group A, group B is under way into the intramedullary nail patella cases adopted.Results: were followed up for 6 months a 2.5 years comparing patellar blood loss on the road bleeding group 60 ~ 260 m L, an average of 112.6 m L; approach group 80 ~240 m L blood loss infrapatellar average of 121.7 m L. There was no significant difference(P> 0.05) groups bleeding. Patellar operation time on operative time 65-110 minutes, with an average 81 minutes; operative time under the control of the patellar60-120 minutes, with an average 89 minutes. Two operative time was no significant difference(P> 0.05). The incidence of patellofemoral pain group before the patellar one case, the next group of six cases of patellar incidence of 5% and 27%, respectively, a total of seven cases of postoperative knee pain, mostly shallow incision knee pain.There are two cases appear medial ankle pain. There was a significant difference(P<0.05) groups of patients the incidence of patellar pain before. Fracture healing time: 18 cases approach the patellar bone healing, two cases of delayed union, mobility of three months after reaching the bone healing. To the last follow-up again without fracture displacement; no internal fixation loosening or fracture displacement; nor fixed around the fracture phenomenon discovered. Infrapatellar approach group 19 cases of bone healing, two cases of delayed fracture healing power of one case up to three months after the fracture healing. Another one case of nonunion, two lines since the fixation of bone graft healing. I fracture healing rate of the patella and patellar group group were90% and 86.4%, fracture healing rate between the two groups was no significant difference(P> 0.05). The number of X-ray projection, projection approach surgery13-32 times the number of patella, an average of 17 times, the road down into the nail patella projection times 18-52 times, an average of 31 times. Two projection times there was a significant difference(P <0.05) operative staff: the road into the patellar group4--8, an average of 6.2 people. Infrapatellar approach group 5--9 average of 6.7 people,two surgical operations staffing was no significant difference(P> 0.05). Postoperative treatment results were followed up for 0.5 years to 2.5 years after surgery, with an average of 1.4 years after surgery in December Johner-Wuchs score 78-100 points, excellent in 30 cases, good in 8 cases, in two cases, the difference 2 cases, good rate of90%. Patella on which 14 cases were excellent, good for four cases, as one cases, the difference is one case. Excellent rate of 90%. The patellar excellent group of 16 cases,good in 4 cases, in one case as poor as one cases, good rate of 91%, the rate of postoperative excellent no significant difference(P> 0.05).Conclusions: Intramedullary nailing of tibial fractures treated in the incidence of anterior knee pain and a number of aspects of radiation exposure on the road than the patellar infrapatellar approach has obvious advantages. |
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