Analysis Of Related Factors And Comparison Of Different Internal Fixation Effects In The Middle And Lower Third Of Tibia Spiral Fracture Combined With Posterior Malleolus Fracture

Objective: To retrospectively analyze the related factors of the middle and lower 1/3 of the tibia spiral fracture combined with posterior malleolus fracture,to provide reference for clinical diagnosis;to compare the curative effect of different surgical internal fixation methods for this type of fracture,to provide theoretical and clinical basis for the selection of reasonable surgical methods support.Methods:1.Analysis of relevant factors: Retrieve the data of 196 patients with spiral fractures in the middle and lower third of the tibia admitted to the Department of Traumatology and Orthopedics of the Third Affiliated Hospital of the University from January 2016 to December 2021,and who met the study inclusion criteria,including general Data: gender,age,height,weight,BMI,direction of the affected limb,injury energy,bone mineral density;imaging data: the length of the tibial fracture line,the distance from the lowest point of the tibial fracture line to the tibial talar articular surface as a percentage of the total length of the tibia.Whether combined with independent posterior malleolus fractures or not was divided into: non-posterior malleolus group,without posterior malleolus fracture,totaling 126 cases;posterior malleolus group,combined with posterior malleolar fracture,totaling 70 cases.By comparing the differences of each index between the two groups,the related risk factors of combined posterior malleolus fractures were discussed.2.Comparison of the efficacy of internal fixation: The above case data were included and excluded,and 64 patients with spiral fractures of the middle and lower third of the tibia combined with posterior malleolus fractures who had received internal fixation were selected and divided into group A according to the internal fixation method.,Group B,in which group A used intramedullary nail combined with cannulated screw method,a total of 35 cases;group B used steel plate combined with cannulated screw method,a total of 29 cases.By observing the preoperative general information(same as above),intraoperative conditions(operation time,incision length,blood loss),postoperative conditions(complications,time to get out of bed,time for fracture healing,ankle function recovery score,hospital stay),After a systematic analysis,the clinical efficacy of the two types of internal fixation was comprehensively compared.Results:(1)After t test,chi-square test and Kruskal-Wallis rank sum test,the results of univariate regression analysis showed that the length of the tibial fracture line(P<0.001),the length from the lowest point of the tibial fracture line to the tibiotalar articular surface accounted for the proportion of the total tibia length(P = 0.003,< 0.05),the above factors were associated with the occurrence of the middle and lower third of the tibia spiral fracture combined with the posterior malleolus fracture.After multivariate Logistic regression analysis,the results showed that the length of the tibial fracture line(OR=1.030,95% CI:1.015,1.046,P<0.001)and the proportion of the length from the lowest point of the tibial fracture line to the tibiotalar articular surface in the total length of the tibia(OR=1.030,95% CI: 1.015,1.046,P < 0.001)=1.079,95% CI: 1.009,1.153,P=0.025)was an independent risk factor for the occurrence of spiral fractures of the middle and lower third of the tibia combined with posterior malleolus fractures.(2)There was a statistically significant difference in curative effect between groups A and B as follows: fracture healing time(P < 0.001),time to get out of bed(P < 0.001),ankle function score(P < 0.001),suggesting that intramedullary Under the same conditions,the fracture healing time,the time to get out of bed and the weight-bearing time were earlier than those of the plate,and the ankle joint function score was better.Conclusion:1.The length of the tibial fracture line and the length of the tibial fracture line from the lowest point of the tibial fracture line to the tibiotalar articular surface accounted for the proportion of the total tibia length.2.The interlocking intramedullary nail combined with cannulated screw is used to treat the middle and lower 1/3 of the tibia spiral fracture combined with the posterior malleolus fracture.Compared with the internal fixation of the plate,it can promote the early healing of the fracture,improve the function of the foot and ankle,reduce the complications,and has a good effect.