| Objective: To explore the therapeutic effect of interlocking intramedullary nail and unilateral multifunctional external fixator for open tibial fracture of Gustilo type Ⅱ and type Ⅲ A.Methods: A retrospective controlled study was conducted in 200 patients with tibial fractures admitted to the trauma surgery department of our hospital from January 2014 to January 2017.Among them,95 were male and 105 were female.The age was(39.57±3.73)years old;the height was(165.33±9.86)cm;the weight was(51.46±2.21)Kg;the open fracture of tibia and fibula was classified by Gustilo classification,100 by type Ⅱ and 100 by type Ⅲ A.It is mainly aimed at open tibial fractures of Gustilo Ⅱ and Ⅲ A with minor skin damage.Both can be treated with internal fixation and external fixator.According to the purpose of this experiment,the type of tibial fracture and the degree of skin injury,200 patients with tibial fracture were randomly divided into two groups according to the digital table method,namely intramedullary nail group and external fixator group.Total blood loss,drainage volume,Hb content,hematocrit(HCT),lower limb circumference,incision healing and subcutaneous ecchymosis were recorded.The clinical efficacy and complications(poor wound healing,malunion,delayed fracture healing,limited joint function,etc.)were evaluated by Johner-Wruhs fracture evaluation criteria.Results: A total of 212 patients with tibial fractures were enrolled in this study,12 of whom were lost to follow-up.The follow-up rate was 94.3%.(1)There was no significant difference in the baseline data such as sex,age,height,weight and BMI between the intramedullary nail group and the external fixator group(P > 0.05);(2)There was no significant difference in the location and cause of tibial fracture between the intramedullary nail group and the external fixator group(P > 0.05);(3)There was no significant difference in the incidence of tibial fracture between the intramedullary nail group and the external fixator group(P > 0.05).There was no significant difference in Gustilo classification and Tscherne-Gotzen score between the two groups(P > 0.05);(4)In the comparison of operative data of tibial fracture patients between intramedullary nail group and external fixator group,the operation time of intramedullary nail group was significantly higher than that of external fixator group(P < 0.05),and the anesthesia time of intramedullary nail group was significantly higher than that of external fixator group(P< 0.05).The number of fluoroscopy in group A was significantly less than that in group B(P < 0.05).(5)There was no significant difference in preoperative hemoglobin betweenintramedullary nail group and external fixator group(P > 0.05);(6)there was no significant difference in preoperative hematocrit between intramedullary nail group and external fixator group(P > 0.05);(7)there was no significant difference in preoperative hematocrit between intramedullary nail group and external fixator group(P > 0.05).There was no significant difference in the total blood loss,transfusion rate and total drainage flow between the external fixation group and the intramedullary nail group(P > 0.05);(8)There was no significant difference in the NRS score of the affected limbs between the intramedullary nail group and the external fixation group(P > 0.05).The NRS score of the affected limbs in the intramedullary nail group was significantly higher than that in the external fixation group on the first day after operation,and it was more systematic.The NRS score of affected limbs in intramedullary nailing group was significantly higher than that in external fixator group 7 days after operation(P < 0.05).The NRS score of affected limbs in intramedullary nailing group was significantly higher than that in subfemoral approach group 30 days after operation(P < 0.05);(9)AOFAS score of affected limbs in intramedullary nailing group and external fixator group before operation.There was no statistical difference(P > 0.05).AOFAS score of affected limbs in intramedullary nailing group was significantly higher than that in external fixation group at 1 week after operation(P < 0.05).AOFAS score of affected limbs in intramedullary nailing group was significantly higher than that in external fixation group at 2 weeks after operation(P < 0.05).AOFAS score of affected limbs in intramedullary nailing group was significantly higher than that in external fixation group at 12 weeks after operation(P <0.05).There was significant difference between fixed stent group and fixed stent group(P< 0.05).Conclusion:(1)Early and correct debridement and fixation is the key to the treatment of open tibial fractures;(2)It is safe to use intramedullary nails for the first stage of Guestilo Ⅱ and ⅢA fractures;(3)Perioperative functional exercise is an important method to prevent joint stiffness and deep vein thrombosis of lower extremities;(4)Rational application of antibiotics and negative pressure suction of wounds can reduce the incidence of postoperative infection. |
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