上膝蓋アプローチを用いた新しい脛骨髄内釘の治療経験

Clinical Results of a New Suprapatellar Approach to the Treatment of Tibial Fractures

　背景：脛骨骨折に対する上膝蓋アプローチを用いた新しい脛骨髄内釘手術と，膝蓋靱帯切開による従来法との比較検討の報告はみられない．

　方法と対象：脛骨骨折に対して手術的加療を加えた30例を対象とした．膝蓋靱帯切開による従来法10例，上膝蓋アプローチ法20例について比較検討した．

　結果：手術時間，術後平均短縮は上膝蓋アプローチ法で有意に少ない結果であった．

　まとめ：従来法での深屈曲位での挿入に伴う挿入困難や骨折部の整復保持困難は，上膝蓋アプローチ法では回避可能であり，軟部組織損傷も少ない有用な術式であると考えられた．

　Background：The purpose of this study was to assess the results of a new suprapatellar approach to the treatment of tibial fractures in comparison with the conventional infrapatellar approach.

　Methods：There were 30 subjects, and they were divided into two groups：a group treated by the suprapatellar approach (SP group, n＝20) and a group treated by the infrapatellar approach (IP group, n＝10).　We evaluated operation time and intraoperative blood loss, and we measured the extent of shortening of fracture site postoperatively.

　Results：The difference between the two groups in mean blood loss was not significant.　Operation time in the SP group (79 min) was significantly shorter than in the IP group (91.8 min) (p＝0.045).　The mean extent of shortening of the fracture site was significantly smaller in the SP group (0.675 mm) than in the IP group (3.54 mm) (p＝0.0016).

　Conclusion：Comparison with the infrapatellar approach to the surgical treatment of tibial fractures showed that the suprapatellar approach was a less invasive and more effective procedure, and that it shortened operation time and prevented malunion.