| Objective (1)During Jan.1,2005 to Dec.31,2009 ,epidemiological survey of distal tibial fractures in the 2nd hospital of Tangshan was performed; (2)The incidence rate of distal tibial fracture is high and treatment methods are various, because intramedullary nail,locking compression plate and anatomical plate are treated distal tibial fracture. At present it is still the dispute which fixator effect was best .The author compares the above three kind fixators through the experiment from the biological mechanics angle the fixed effect. The hope to provide some references for the clinical care distal tibial fracture.Methods (1)From January 1st, 2005 to December 31, 2009 the complete distal tibial fractures from the hospital medical record room were assembled. The design survey form carries on the correlation factor registration. The dynamic analysis were carried on and the situation for 5 years for the distal tibial fracture's popular characteristic; (2)24 right flank tibia skeleton model, randomly divided into two groups, 12 in each group. Transverse in group one, osteotomy in group two. The transverse group is doing a transverses fracture model on tibial distal articular surface 6cm place. The osteotomy group was making 1cm osteotomy from tibial distal articular surface 6cm place upwardly and created 1cm bone damage. 3 groups were randomly assigned to 3 shares at 4 each. Randomly by intramedullary nail,locking compression plate and anatomical plate gives fixed. In the intramedullary nail group , the proximal fracture block has 2 lock nails to be fixed, distal block has 3 lock nails to be fixed;In the locking compression plate group , fracture proximal has 3 lock nails to be fixed, fracture distal has 4 lock nails to be fixed;In the anatomical plate group , fracture proximal has 3 screws to be fixed, fracture distal has 4 screws to be fixed.The locking compression plate and anatomical plate were fixed on distal tibial medial aspect. The biological mechanics testing machine included the main engine,accessories by the Changchun Testing machine Research institute Limited company produces,the EDC digit controller by the German DOLI Electron Company produces and the computer system . Carries on the pressure, the torsion, the pressure torsion and the bending force test. In transverse group ,the pressure was 0～1000N,the torsion was 0～5N·m,the pressure torsion pressure range was 0～800N, the torsion was 0～5N·m,the bending force was 0～500N;In osteotomy group ,the pressure was 0～800N,the torsion was 0～5N·m,the pressure torsion pressure range was 0～700N, the torsion was 0～5N·m,the bending force was 0～500N. In the test the load speed respectively were 4mm/min of the pressure,80/min of the torsion,5 mm/min, 40/min of the pressure torsion and 2mm/min of the bending force.There were carring on the clockwise rotation and the anticlockwise rotation test in the osteotomy group , to compare whether the fixator to the different direction anti- rotation to be was same . The torque force was 0~5N·m. Simultaneously carries on between transverse group and the Osteotomy group comparison, judges the influence of the different fracture model to internal fixator clamping action .We Used the SPSS13.0 statistics software to carry on variance analysis of the repeated measure material.Results (1) From January 1st, 2005 to December 31, 2009 ,all admiting the distal tibial fracture patient were 105 examples, And IMN group were 41 examples, LCP group were 12 examples, AP group were 52 examples. The morbidity age concentrates in 20～59, about 80.8﹪of the cases;The rate of male to female was 5.56:1; Farmers and worker were the majority with the rate of 83.81%. Injury Reasons: The transportation injuries 52 people, accounts for the total 49.52%; The high fall 23 people, accounts for the total 21.90%; Falls 8 people, accounts for the total 7.62%; Crushes injures 11 people, accounts for the total 10.48%; The other injures 11 people, account for the total 10.48%; By AO/ASIF classification,there were type 42-A in 60 cases, account for total 57.1%;type 42-B in 5 cases, account for total 4.8%;type 42-C in 40 cases, account for total 38.1%; Closed soft tissue injury 98 people, account for total 93.3%, Opened soft tissue injury 7 people, account for total 6.7%;The rate of open reduction: In the IMN group 41 examples has all close reduction, In the LCP group 11 examples has a example technique to adopt the small margin, is the limited incision, in the AP group 52 examples has 20 examples is the open reduction, approximately composes the total 38.46﹪; Complication situation:The IMN group has a example of the malleolus joint activity to receive limits, the LCP group has not discovered the serious complication, the AP group has two examples to have the infection, a example malleolus joint activity to limit, a example delayed union , other not serious complication; The average admission days of the IMN group,LCP group and AP group are 17.98±6.624,15.83±4.324,18.67±10.588,Three groups differences do not have statistics significance(P=0.592).(2)Transverse fracture model , statistics significance of the pairwise comparison to see the next table: (Note: the @#* mark same expression that difference was not statistics significance.) Osteotomy fracture model , statistics significance of the pairwise comparison to see the next table: (Note: the @#* mark same expression that difference was not statistics significance.) The comparison of clockwise rotation and anticlockwise rotation: This was not statistics significance in IMN group(P﹥0.05);This was statistics significances in LCP group(P<0.05). This was statistics significances in AP group(P<0.05). The comparison of transverse group and osteotomy group: This was statistics significances in the pressure test the transverse group and osteotomy group(P<0.05). This was statistics significances in the torsion test the transverse group and osteotomy group(P<0.01). This was statistics significances in the pressure torsion force test the transverse group and osteotomy group(P<0.05). This was statistics significances in the bending force test the transverse group and osteotomy group(P<0.01).Conclusion (1)The incidence of distal tibial fracture was high in middle and young age male.The major part of patients were workers and peasants. The patients associated with traffic accident, high fall and heavy power injury in the group were 81.9%. The fracture type was dominated by spiral fracture.The closed damage is higher than the open damage obviously, AP group frequently receiveed open reduction, postoperative complications obviously increased comparing with other groups.This could be due to an association with intraoperative open reduction. The average admission days of the IMN group,LCP group and AP group are basically the same(.2)In the anti-axial compression stable aspect, the IMN is better than LCP and AP.The anti-compression of LCP were similar to AP . In the anti-torsion stable aspect, the IMN is better than LCP and AP, the anti-torsion of LCP is better than AP ; In the anti-bending stable aspect, the IMN is better than LCP and AP, the anti-bending of LCP is better than AP . There is no difference of IMN in clockwise rotation and anticlockwise rotation test, There are a few differences in LCP and AP. This could be due to an association with the central fixation of IMN and the eccentric fixation of LCP and AP. In comparison of the pressure, the torsion, the pressure torsion and the bending force test transverse group was better than osteotomy group . |
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