Comparative analysis of the parapatellar and subpatellar approaches in reducing peripheral knee pain post-intramedullary tibial fracture surgery.

IF 1.6 3区 医学 Q2 SURGERY
Shaoyu Han, Bingjun Cui, Lang Wu, Chuangong Wang, Zhixiang Chen
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Abstract

Introduction: Intramedullary tibial nailing is a standard treatment for tibial shaft fractures. Postoperative knee pain significantly impacts functional recovery; however, studies on this issue are limited. This study evaluated the effect of the parapatellar approach for intramedullary nailing on postoperative knee pain.

Materials and methods: A total of 29 patients with tibial shaft fractures treated with intramedullary nails from March 2019 to January 2022 were divided into two groups based on the surgical approach: the semi-extended lateral parapatellar approach and the conventional subpatellar ligament split approach. Recorded metrics included operation time, intraoperative fluoroscopy count, intraoperative bleeding volume, Visual Analog Scale (VAS) scores for knee pain at 24 h, 72 h, 1 week, and 1 month postoperatively, fracture healing time and Lysholm knee functional scores at 12 months.

Results: Both groups completed the operation without significant differences in operation time, intraoperative bleeding, fracture healing time, or intraoperative fluoroscopy (P > 0.05). The parapatellar group showed significantly better VAS scores for knee pain at 24 h, 72 h, and 1 week postoperatively compared to the control group (P < 0.05), with no significant difference at 1 month. After 12 months, Lysholm scores indicated no significant differences in knee support, locking, and swelling (P > 0.05); however, the parapatellar group showed significant improvements in lameness, instability, stair climbing, squatting, and pain (P < 0.05). Overall, the parapatellar group outperformed the control group (P = 0.01). Additionally, long-term follow-up revealed potential advantages of the parapatellar approach in improving long-term functional outcomes.

Conclusions: Using the parapatellar approach for tibial intramedullary nailing avoids splitting the patellar ligament and entering the joint cavity, minimizing knee joint impact and effectively reducing postoperative knee pain, with potential benefits in long-term functional recovery.

髌骨旁入路与髌骨下入路减轻胫骨髓内骨折术后周围膝关节疼痛的比较分析。
简介:胫骨髓内钉是治疗胫骨干骨折的标准方法。术后膝关节疼痛显著影响功能恢复;然而,关于这个问题的研究是有限的。本研究评估髌旁入路髓内钉治疗术后膝关节疼痛的效果。材料与方法:选取2019年3月至2022年1月29例经髓内钉治疗的胫骨干骨折患者,根据手术入路分为半延伸外侧髌旁入路和常规髌下韧带劈开入路两组。记录的指标包括手术时间、术中透视计数、术中出血量、术后24小时、72小时、1周和1个月的膝关节疼痛视觉模拟评分(VAS)、骨折愈合时间和12个月的Lysholm膝关节功能评分。结果:两组均完成手术,手术时间、术中出血、骨折愈合时间、术中透视等差异无统计学意义(P < 0.05)。髌旁组术后24 h、72 h、1周膝关节疼痛VAS评分明显高于对照组(P < 0.05);结论:髌旁入路行胫骨髓内钉可避免撕裂髌骨韧带并进入关节腔,最大限度地减少对膝关节的冲击,有效减轻术后膝关节疼痛,对长期功能恢复有潜在的益处。
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来源期刊
BMC Surgery
BMC Surgery SURGERY-
CiteScore
2.90
自引率
5.30%
发文量
391
审稿时长
58 days
期刊介绍: BMC Surgery is an open access, peer-reviewed journal that considers articles on surgical research, training, and practice.
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