Therapeutic Effect Of Intramedullary Nailing Combined With Plate Or Pull Nail In The Treatment Of Tibial Plateau Fractures In The Middle And Lower Tibia

The research background:As a result of a car accident and other high-energy damage gradually increased,tibial plateau fractures are also becoming more common.Tibial plateau fractures often accompanied by soft tissue injury,can also be combined tibial shaft fracture.Tibial plateau is the site of human body weight,but also intra-articular fractures,requires strong fixation of fractures and stability of the knee.Most tibial plateau fractures with ligament,meniscus injury,if not effective treatment,can cause instability of the knee,knee pain and other complications.With the continuous development of internal fixation materials,especially the appearance of anatomical plates and LISS plates,for tibial plateau fracture reduction and fixation has a good effect.When the tibial plateau fractures in the middle and lower tibia,due to the special anatomical characteristics of the lower tibia,easily lead to complications such as infection,skin necrosis.Such as the simple treatment of steel,incision longer and stripping more easily lead to a variety of soft tissue complications.Although intramedullary treatment of long bone fracture greater advantages,due to the limitations of the existing tibial intramedullary nail alone can not be used on the tibial plateau is firmly fixed.This article retrospectively analyzed the undergraduate tibial plateau merged with the lower fracture,to explore the effect of interlocking intramedullary nail combined with steel plate or pull nail in the treatment of such fractures,in order to give some advice in clinical practice,more than one surgical approach.Materials and Methods:This retrospective study,from October 2015 to January 2018 in the Third Hospital of Jilin University author treatment group treated 43 cases of tibial plateau tibial plateau fractures,all patients were divided into A,B two groups.Among them,group A was treated with intramedullary nailing combined with steel plate,the ratio of male to female was 10/9,and the average age was from 21 to 71 years with an average of 40.16 ± 14.818.Group B was treated with steel plate only,the ratio of male to female was 15/9,and the average age was 20.78 ± 18.922.Schatzker classification was used mainly in group A,including 2 cases of Schatzker type Ⅰ,9 cases of type Ⅱ,3 cases of type Ⅲ,1 case of type Ⅳ,2 cases of type Ⅴ and 2 cases of type Ⅵ.In group B,there were 5 cases of Schatzker type Ⅰ,6 cases of type Ⅱ,4 cases of type Ⅲ,3 cases of type Ⅳ,3 cases of type Ⅴ and 3 cases of type Ⅵ.Postoperative routine dressing and functional exercise.Surgical methods:Preoperative preparation: preoperative 6 disappeared fasting water,blood,half an hour to one hour before surgery to prevent the application of antibiotics.Definitive no contraindications to surgery, electrocardiogram,chest anteroposterior,knee lateral and knee CT and other related tests,to develop surgical options;If the patient is an open fracture,depending on the condition of the wound,given external fixator or bone traction treatment,the wounds are routinely given debridement and suturing.The wounds are taken for bacterial culture.Sensitive antibiotics are used to prevent infection.Sick limb swelling to be alleviated,patients with wound secretions negative after elective surgery.Surgical procedure:Using epidural anesthesia or general anesthesia,the patient supine position,if it is Schatzker type I fractures in the C arm fluoroscopy to take a closed reduction,such as the feasibility of incision and reduction can not be reset,straighten the knee,hands traction,rotation of the tibia for reset,C-arm under the articular surface smooth,cloth with a large cloth towel clamp,with Kirschner wire temporary fixation,select the appropriate length of cancellous bone Rafah nail fixed.If Schatzker Ⅱ Ⅲ Ⅳ-type feasible ipsilateral oblique incision,and the platform below the compression fracture window,with an osteotome pry up the collapse of the articular surface,in the gap at the implantation of allogenic bone.Tensile forceps clamp temporary fixation,select the appropriate length of the anatomical plate,the lower edge of the tibial plate into the 4 row nail,the distal end of the plate in order to not affect the nail into the nail can be used cortical nail.Take the next lower incision of the patella,about 5cm,revealing the tibial tubercle,and then knees,hip flexion,calf traction in the tibial tubercle slope with bone cone down through the cortical bone,electric drill opening,the round head guide inserted into the medullary cavity,Until about 2cm on the ankle.Open reaming,select the appropriate intramedullary nail,rotate the tibia until the distal insertion,insert the assistant before the nail should pay attention to maintaining the stability of the knee.At any time,pay attention to the choice of proximal locking point at any time,at any time to correct the angle to maintain the knee ankle axis consistent,and try to keep the limb and the contralateral length consistent.Then start to lock the nail,generally close the first lock and then lock the distal end.In the event of segmental separation,the gap may be reduced by striking the proximal handle proximally.C-arm after the nail locking perspective,check limb flexion and extension activities,suture repair ligament,irrigation suture incision.Results:The intramedullary needle group and the plate group were compared,there was no significant difference in knee mobility,knee function score and knee joint stability(P> 0.05).There was significant difference between the two groups in intraoperative blood loss,operation time,incision length and postoperative drainage volume(P <0.05).The intramedullary needle group was slightly smaller than the plate group.Conclusion:The treatment group because of the small number of cases,the results may be specific,but the intramedullary nail combined with steel plate or pull nail treatment of tibial plateau fracture combined with the lower tibia,knee function and stability after surgery,and the tibial periosteum And soft tissue damage is smaller,reducing the risk of postoperative skin necrosis and nonunion,postoperative patients with knee flexion can reach 90 °.Currently considered as a treatment of tibial plateau fractures in the middle and lower tibia fractures of a method for the metaphyseal comminuted fracture or severe fractures can be selected depending on the fracture treatment of intramedullary nailing.