The Application Of Blocking Nail Technique In Treating Femoral Shaft And Tibial Shaft Fractures With Intramedullary Nail

purpose: The intramedullary system is a very effective treatment for femoral and tibial fractures.Compared with traditional fixed materials,the integrity of the blood supply to the periosteum and surrounding soft tissue is more protected.With the continuous expansion of the application of intramedullary nails,the intramedullary fixation system has also exposed many problems.For example,in the long oblique or spiral fracture of the backbone,in the process of intramedullary nail fixation of the proximal and distal diaphyseal fractures,the stability of the fracture end after intramedullary system fixation is poor,the number of intraoperative fluoroscopy is too many,and lateral displacement occurs.The use of blocking nail technology in combination with intramedullary nailing in the treatment of femoral,tibial and metaphyseal fractures,evaluation of the assistive role of blocking techniques in surgery,and the collection of related cases,explored the use of blocking nails for fracture reduction and stability.method: A retrospective study of the Department of Trauma Orthopaedics of the First Hospital of Jilin University.From October 2015 to August 2017,18 cases of long bone fractures of the lower extremities were treated with intramedullary nails.Patients with complete follow-up data were followed for an average of 8 months.There were 10 cases of femoral fractures and 8 cases of tibial fractures.They were divided into experimental group and control group.Blocking nail technique combined with intramedullary nail fixation group was used in the experimental group,including 8 cases of long bone fractures,1 case of long bone metaphyseal fractures,1 case of femoral reconstruction nails,and 4 cases of retrograde intramedullary nails.4 cases were treated with intramedullary nails,3 cases were treated with simple intramedullary nails,1 case was treated with intramedullary nails in tibial fractures with tibial plate,and 4 cases were open fractures.In the simple intramedullary nailing group,there were 8 patients with long bone fractures,1 patient with long bone metaphyseal fractures,1 patient with femoral reconstruction nails,4 patients with retrograde intramedullary nails,and 4 patients with bone marrow defects.4 patients were treated with internal nails,3 patients were treated with simple intramedullary nails,1 patient was treated with intramedullary nails in tibial fractures with intramedullary nails,and 2 patients were treated with open fractures.The same treatment was given before and after surgery.The operation time,intraoperative blood loss,and fracture healing time were compared between the two groups.Statistical analysis was performed using spss20 software to obtain the results.Schatkzker lambert femur fracture scoring system and Johner wruh tibial fracture scoring system were used to evaluate functional recovery after femoral and tibial fractures.Compare.result: All 18 patients were followed up for an average of 8 months.Except for the postoperative knee pain symptoms in 1 patient in the blocking nail and intramedullary nail group,no significant complications occurred in the remaining 17 patients.Six months after surgery,all patients healed with bone and walked with weight.No complications such as incision infection,fracture of internal fixation,loosening of internal fixations occurred after operation.The average operation time(69.4 ± 7.2)points for the blocking nail technique combined with intramedullary nail group and(95.0 ± 8.6)minutes for the simple nailing group.p<0.05.There was a significant difference between the two groups in the operation time.The mean intraoperative blood loss(144.4±52.7)ml in the intramedullary nail group and the average intraoperative blood loss(133.3±50)ml in the simple intramedullary nail group was determined.P value = 0.65,p> 0.05,no statistically significant difference.The average bone healing time of the blocking nail technique combined with the intramedullary nail group was(14.8±1.6)weeks.The mean bone healing time was 14.8±1.2 in the simple intramedullary nail group.P-value = 1,p> 0.05,no significant statistical difference.The schatzker lambert femoral fracture scoring system and the johner wruh tibial fracture scoring system were used to evaluate the functional recovery of patients after fracture.The use of blocking nails combined with intramedullary nail group was excellent in 5 cases,good in 3 cases,moderate in 1 case,and poor in 0 cases.One patient had knee joint pain after operation.The good rate was 88.8%.Simple application of intramedullary nail group was excellent in 3 cases,good in 5 cases,moderate in 1 case,and poor in 0 cases.The good rate was 88.8%.Conclusion: The purpose of intramedullary nailing in the treatment of femoral and tibial fractures is to maintain a good alignment of the fracture and promote fracture healing.When the fracture end is closed and poorly restored,the application of the blocking nail technique saves the operation time and avoids the repeated destruction of the blood supply around the fracture end,which provides a certain guiding role for clinical work.