| In clinical work,the tibial shaft fracture caused by trauma of various reasons is more common.As the tibia is the main bone connecting the lower part of the femur to support the body weight,it plays a very important role.The primary treatment of diaphyseal fractures is to restore the load-bearing function of the lower leg.Therefore,the angular deformity and rotation displacement of the fracture end should be completely corrected,so as not to affect the weight-bearing function of the knee ankle joint and cause joint strain.In the past,the treatment effect of plum shaped intramedullary nail was not good.Later,contact steel plate,external fixation frame,interlocking intramedullary nail and expandable intramedullary nail were used.Through clinical practice,interlocking intramedullary nail can be used in almost all tibial shaft fractures.Good clinical effect makes intramedullary nail play an important role in the treatment of tibial shaft fractures,and has gradually become the first choice for the treatment of closed tibial shaft fractures.With the development of clinical research,it has been found that the common interlocking intramedullary nail aiming positioner is not accurate,the distal one-time locking success rate is low,there is more bleeding,the doctor-patient radiation exposure time and the operation time is long.In order to solve this problem,researchers have put forward many new technologies and new methods,such as surgical robot positioning system,computer navigation,spot center of gravity positioning and other intramedullary nail remote locking technology,but the above technical requirements are equipped with too expensive medical equipment,so it has not been effectively promoted and applied.Meta nail,or magnetic navigation intramedullary nail,uses the relatively simple principle to transform the electromagnetic signal into visual signal,which makes the operation visual,and makes up for the imprecise locking of the common exchange intramedullary nail,thus reducing the problems such as large side injury,more bleeding,more radiation exposure and long operation time caused by repeated puncture,which is gradually recognized by everyone.Objective:To explore the clinical effect of meta nail and common interlocking intramedullary nail in the treatment of tibial shaft fracture,so as to provide reference for the selection of treatment plan of tibial shaft fracture.Method:From August 2016 to October 2018,83 cases(n = 83)of closed tibial shaft fracture were selected,including 41 cases of traffic injury(49%),36 cases of falling injury(43%)and 6 cases of crush injury(8%).According to AO classification: 40 cases of type A,29 cases of type B,14 cases of type C.There were 56 male(67%)and 27 female(33%),35 left(42%)and 48 right(58%).All the patients had no serious combined injuries or diseases affecting fracture and wound healing.39 cases in the control group(N1 = 39)were in the common interlocking intramedullary nail group.There were 27 males(69%)and 12 females(31%);14 left(36%)and 25 right(64%);the average age was 39.00 ± 8.18 years(22-65 years).The mechanism of injury: traffic injury in 19 cases,fall injury in 16 cases,crush injury in 4 cases.44 cases(N 2 = 44)in the observation group were in the magnetic navigation intramedullary nail group.There were 28 males(64%)and 16 females(36%);13 left(30%)and 31 right(70%);the average age was 38.00 ± 7.28 years(25-60 years).Injury mechanism: traffic injury in 22 cases,fall injury in 19 cases,crush injury in 3 cases.Observe the success rate,bleeding volume,radiation exposure time and operation time of the two groups.Compare the difference between the two groups by statistical method,and observe whether the difference has statistical significance.Results:The data of 83 patients in the two groups were reviewed.All patients were followed up for 12-24 months,with an average of 18.2 months.All the patients had no wound infection,skin necrosis and malunion after 14 days of operation.The operation time of distal locking was 7.4 ± 1.3min and 9.6 ± 2.1 in the observation group and the control group,the success rate of one-time locking was 96.9% and 83.8% respectively,the average times of fluoroscopy was 0 and 5.03 ± 1.9,the amount of intraoperative bleeding was 60.8 ± 25.9 and 91.7 ± 26.4 respectively,and one year after the operation,the patient passed Lysholm knee joint scoring system The scores of limp were 92.2 ± 5.1 and 87.7 ± 7.8,respectively.According to the Johner wruh efficacy evaluation standard,the number of patients with excellent limb was obtained from the scores of postoperative pain,gait,deformity and range of motion,and then the clinical excellent rate was 96.3% and 80.1% respectively.Their p values were all less than 0.05,the difference between the two groups was statistically significant.The time of fracture healing was 16.1 ± 1.9 weeks in the observation group and 16.8 ± 2.3 weeks in the control group,P > 0.05,there was no significant difference between the two groups.Conclusion:Magnetic navigation intramedullary nail(meta nail)is superior to common interlocking intramedullary nail in the treatment of tibial shaft fracture.It does not need fluoroscopy when locking the distal end,improves the success rate of one-time locking,reduces the operation time of locking the distal end and the amount of bleeding during the operation.One year after the operation,Lysholm knee joint score and clinical excellent rate are significantly improved.It provides a new way for orthopedic doctors to treat tibial shaft fracture and is worth popularizing in clinical practice. |
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