Clinical Observation About Two Methods Of Internal Fixation To Treatment For Lower Limb Shaft Aseptic Nonunion

Objective:To retrospect the clinical efficacy of the intramedullary nail fixation or bridging plate fixation to lower limb shaft aseptic nonunion, and to analyze the difference between these two treatments.Methods:From January 2008 to September 2010,55 patients with aseptic Nonunion and pseudarthrosis of lower limb longbone were treated either in the Department of Lower Extremity Trauma, Sichuan Province Orthopedic Hospital or the Department of Orthopaedics, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine. The treatment was either intramedullary nail fixation or bridging plate fixation. 44 cases were follow-up, but 11 cases were failed to follow. In these 44 cases,30 cases were males and 14 cases were females. Their ages ranged from 21 to 74 years old. The mean age was 40.02 years old. In these 44 patients,24 patients were given the bridging plate fixation, and the other 20 patients were given the intramedullary nail treatment. Besides, all the patients were given the electro-acupuncture and guided functional training. Then the patients were assessed and analyzed by the average operation time, X-ray bone callus score, hip-knee-ankle Score System, healing time, clinical assessment, complications and other indicators.Results:After treatment, the patients were follow-up 8 to 32 months(20.55 months on average).All Patients were healed completely, without infection, poor wound healing and other complications. The operation time was 111.75±19.49 min (intramedullary nail fixation group), and 157.92±34.20min(bridging plate fixation group), P<0.01. The operation time of intramedullary nail fixation group was shorter compare to the bridging plate fixation group. X-ray bone callus score was 3.60±0.50 (intramedullary nail fixation group), and 3.92±0.28 (bridging plate fixation group) p<0.05. The X-ray bone callus score of intramedullary nail fixation group was lower than the bridging plate fixation group. The healing time was 6.05±1.15 months in intramedullary nail fixation group, and 4.94±0.63 months in bridging plate fixation group, p<0.05. It is obviously that the healing time in intramedullary nail group was longer. All the assessments showed significant difference. However the function of joint did not show significant difference(p> 0.05). The clinical assessments of both groups were ideal, since all patients were healed completely. There is no significant difference(p> 0.05).Conclusion:Both methods have ideal clinical efficacy, and their own advantages. For fixation selection, clinicians should be based on the level of their skills, the economic status and previous trauma history of patients to choose the most beneficial internal fixation for patients.