Clinical Study On Three Proximal Approach Of Interlocking Intramedullary Nail In The Treatment Of Tibial Fracture

Objective: To Investigate three different surgical path intramedullary nail(IMN) fixed operative time, blood loss, healing time and postoperative kneefunction effects and incidence of pain, and to analyze the factors leading topostoperative complications for tibia Select fractures intramedullary nailfixation of surgical approach and provide the basis for future research and sharesome experience and surgical skills and experience aspects of functionaltrainingMaterials and methods:A retrospective study from August2012toNovember2014period, tibial fracture patients in our hospital for treatment oforthopedic trauma study group got58cases after the screening. All patients hadhigh-energy injuries, including a car accident injury, bruise,) are used indomestic or imported interlocking intramedullary nail, diameter8-10mm.Length280-360mm, of which34males and24females. Age16-63years ofage, the average age of48.5years. Trauma causes:32cases of traffic accidents,falls15cases, falls injury in11cases.58patients were divided into the road byhand A, B, C three groups, A group approach by the patellar tendon group of28patients in group B by the side of the patellar ligament approach13patientsin group C into the path set by the patellar17patients. Each group recorded acorresponding operative time, blood loss, etc., during hospitalization began early exercise under the guidance of doctors. According to the review ofpostoperative follow-up were recorded healing time, with or without infection,compartment syndrome, complications such as nonunion, and apply uniformstandards for the evaluation of motor function of the knee to knee function andpain scores after assessment of the book incidence. The average follow-up of18months (minimum12months, maximum20months). All fractures werefresh fractures, injury to operation time1-7days. Patients without mentalillness, trauma former activities of daily living without limitation, exclusioncriteria: old fractures, pathologic fractures, merger or osteoarthritis of the kneeinjury. Statistical Methods: SPSS18.0(IBM Corporation, USA) statisticalsoftware package for data processing, measurement data with the mean plus orminus standard (±S) said measurement data were compared using analysis ofvariance, P <0.05was statistically significance.Results: For surgery related indicators such as operation time, blood loss,such as recording and analysis, patients were closely followed up includingpreoperative and postoperative radiographic (X-line, three-dimensional CT)and the rate of postoperative anterior knee pain, surgery After knee range ofmotion, walking function, activities of daily living.58patients were followedfor12to20months, with an average of18months. The vast majority havereached clinical healing fracture criterion, healing time is75-85days, anaverage of81days, there appeared one case of nonunion, consider the reasonfor the closed reduction is not satisfactory, nail position offset. There are a routine "by the patellar ligament approach" Pseudomonas aeruginosa infectionin patients after surgery, after a surgical debridement, fluoroquinoloneanti-inflammatory treatment after one week of wound healing, not pull out nail.Approach by the patellar tendon group of10cases of mild to moderatepostoperative knee pain; patellar ligament approach by the next group of eightcases of mild to moderate postoperative knee pain, patellar ligament approachby the group of four cases of intraoperative After mild to moderate knee pain.Three groups of patients after knee score was83-95, with an average91points,one case of open fractures in patients with open wounds minor skin abrasions,after debridement, infection control approach underwent intramedullary nailpatella, intraoperative The surface does not appear after incision and woundinfection, two weeks after the regular dressing wound healing. All cases had noloosening of internal fixation, pull, break and so on. According to the consentof postoperative knee function score standard score,58patients were excellentin47cases, good in10cases, in one case, differential cases, the total fine was98.2%. A bone bleeding volume B group A, group C P <0.05, the differencewas statistically significant, group B and group A, P>0.05, the difference wasnot statistically significant, that is, through the patellar tendon on the approachroad and through the patellar Apocrypha patellar approach than intramedullarynail fixation of tibial fractures in the book less bleeding. Surgical time indexgroup A and group B, between group A and group C compared with P>0.05,the difference was not statistically significant, group B and group C P>0.05, the difference was not statistically significant, namely through the patellarligament approach, by No significant difference beside the road and into theroad by patellar intramedullary nail fixation of tibial fracture patella time.Healing time and postoperative infection, nonunion, compartment syndromeincidence indicators A, B, C three groups P>0.05, the difference was notstatistically significant, that is, three groups of hospital stay, and postoperativerelated fracture healing time Complications no significant difference.Postoperative pain and function scores between group A and group B, betweengroup A and group C compared with P <0.05, statistically significant differencein group B and group C P>0.05, the difference was not statistically significant,namely through the patellar ligament comparison of the road on the way intothe next approach patella and patellar after intramedullary nailing of tibialfracture fixation high incidence of postoperative anterior knee pain. One patientgroup by the patellar ligament surgery reamed improper operation of thepatellar ligament tear, significant postoperative anterior knee pain anddysfunction after ligament sutures. The rest had no unexpected surgery.Conclusion: With the progress of scientific development theory, the useof intramedullary nail in the treatment of tibial fracture fibula or mergegradually become a consensus, and have achieved good clinical results, for therelevant surgical approach and surgical position, postoperative complicationsrelated research there are still differences. And by the way, compared patellarligament, by the way side ways and patellar patellar tendon has a better knee function and lower incidence of knee pain; and patellar ligament and patellarapproach compared to the way, the next way patellar ligament more bleeding,no difference in time indicators addition, a three time in surgery, to heal.Factors leading to postoperative knee pain include: direct approach by Binligament ligament damage to skeletal reamed intramedullary file damageduring operation of the internal structure of the knee. Intraoperative delicateoperation, protection and reconstruction of soft tissue is very beneficialoutcome. In this study, due to the limited number of cases, follow-up data is notperfect, there are a number of research and discussion to be continued.