| BackgroundFractures of the middle and distal tibia are very common in fractures of the lower extremities.The pain,swelling,skin damage,and dysfunction caused by the limbs seriously affect the normal life of patients.For the treatment of middle and distal tibia fractures,it is nothing more than conservative treatment and surgical treatment.In the face of various options,clinicians also need to carefully consider.In recent years,MIPPO technology combined with LCP and interlocking intramedullary nail technology has been widely used in the treatment of long tubular bone fractures,and its effect is significant.Therefore,in the treatment of the middle and distal tibia,a large amount of literature proves that it can better exert its unique advantages.ObjectiveTo evaluate the minimally invasive percutaneous plate osteosynthesis(MIPPO)technology combined with LCP(Locking compress plate)and Interlocking intramedullary nail(IMN)fixation system for the treatment of the middle and distal tibia The short-term treatment effect of fracture,analyze the advantages and disadvantages of the two surgical methods,and evaluate the safety,practicability,rationality and effectiveness of the two surgical methods.MethodA total of 64 patients with middle and distal tibial fractures treated in the Trauma Treatment Center of Henan Provincial People’s Hospital from January 2018 to January 2019 were collected.According to the differences in the internal fixation methods used,MIPPO technology combined with LCP internal fixation was classified into the steel plate group,and IMN internal fixation was classified as the interlocking intramedullary nail group.There were 31 patients in the steel plate group,20 males and 11 females;aged 18-65 years,with an average of 42.9 ± 14.1 years;33 patients in the interlocking intramedullary nail group,22 males and 11 females;aged 18-64 years,The average was 42.1 ± 12.8 years old.According to AO / ASIF classification of tibiofibular fractures,the plate group: 7 cases of type A,13 cases of type B,and 11 cases of type C;interlocking intramedullary nail group: 10 cases of type A and 15 of type B There were 8 cases of type C,of which 16 cases were combined with steel plate and fibula fracture,and 20 cases were in the interlocking intramedullary nail group.Record the relevant data and data of the perioperative period,and conduct retrospective analysis at the same time.The follow-up visits and telephone video will be used to make regular follow-up visits and out-patient complications.Register.Statistical knowledge was used to compare the general clinical and imaging data of the two groups of patients,which mainly included the two groups in terms of age,gender,BMI(Body mass index),fracture classification,combined fibula fractures,number of days before surgery,operation time,blood loss,and hospitalization costs.,Postoperative complications,complete weight bearing time,fracture healing time and other data differences,Johner-Wruhs tibial fracture scoring system was used to evaluate the 1 year after operation recovery function of the affected limb.Result The follow-up time of the final two groups was about 12-20 months(mean 14.5 months).In the comparison of general data between the two groups,there was no significant difference in age,gender,BMI,fracture classification,and fibula fractures(P> 0.05).In the comparison of relevant data during the perioperative period,there were no significant differences in the number of preoperative days,fracture healing time,and complete weight bearing time(P> 0.05),but the time of the plate group was significantly longer than that of interlocking intramedullary nails.Group(P<0.05),the blood loss during operation was significantly smaller than that of the interlocking intramedullary nail group(P<0.05).In terms of hospitalization costs,the hospitalization cost of the steel plate group was also significantly less than that of the interlocking intramedullary nail group.There was a statistically significant difference.Significance(P<0.05).In fibula fracture fixation,there were 10 cases in the steel plate group and 13 cases in the interlocking intramedullary nail group.There was no significant difference between the two groups(P>0.05).In terms of postoperative complications,there was 1 case of skin necrosis and infection in the postoperative plate group,1 case of delayed healing,1 deformity healing,1 case of pain at the knee and ankle joints;1 case of intramedullary nails in the interlocking intramedullary nail group The phenomenon of insecure fixation included delayed fracture healing in 1 case,healing of deformity in 1 fracture,and pain in the knee and ankle joints.There was no significant difference in the incidence of complications between the two groups(P>0.05).At the 1 year after operation follow-up,the Johner-Wruhs scoring system was used to compare the two groups of results to the steel plate group: excellent in 23 cases,good in 6 cases,fair in 2 cases,and poor in 0 cases;interlocking intramedullary nail group: excellent in 23 cases,good There were 7 cases,2 cases being fair,and 1 case being poor.There was no significant difference in scores between the two groups(P>0.05).ConclusionMIPPO technology combined with LCP plate internal fixation and interlocking intramedullary nailing technology for the treatment of middle and distal tibial fractures conforms to the BO biomechanical principle of fixation.Both can be used as a good fixation method,and can effectively reduce the iatrogenic injury of soft tissue and accelerate Healing of fractures and broken ends reduces surgical-related complications,which is in line with the concept of rapid rehabilitation surgery.At the same time,it can obtain satisfactory results and is worth promoting.MIPPO combined with LCP plate internal fixation is ideal for fracture reduction and stable fixation.In terms of economic cost,the savings in hospital costs of the plate group are also significantly better than those of the interlocking intramedullary nail group.IMN technology has a short operation time,simple operation,early weight-bearing,beautiful incision,and more prominent in protecting soft tissue. |
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