髌上入路髓内钉治疗胫骨干骨折的研究进展

Tibia fracture is the most common one among the long bone fractures. The treatment included open reduction and internal fixation ( ORIF ), minimally invasive plate osteosynthesis ( MIPO ), external fixator and intramedullary nailing ( IMN ). The technology of tibia intramedullary nailing was first put forward by Kuntscher. Intramedullary nailing ( IMN ) was preferred for most tibia shaft fractures, because of its advantage of minimal surgical dissection with appropriate preservation of blood supply, with fewer complications and re-operations. Classic approach of tibia intramedullary nailing was conducted either through or near the patellar tendon. Both technologies required a hyperflexed knee, which was easy to cause the proximal tibia fracture angulation deformity. The rate of chronic anterior knee pain was reported varying from 10% to 70%, with an average of 50%. A semi-extended suprapatellar approach was described, with advantages of shorter operation time, lower incidence rate of postoperative knee pain and fracture malunion. However, some considered the suprapatellar approach may increase the patellofemoral joint surface pressure which may cause the damage of patellofemoral joint surface, or injurg of important soft tissue structures such like meniscus within the knee joint. This review summarizes the researches on the suprapatellar approach with intramedullary nails for the treatment of tibia shaft fractures.