A Preliminary Study Of A New Type Of Tibial Interlocking Intramedullary Nail With A Modified Lateral And Superior Approach To The Tibial Tubercle

Objective: To explore the specific approach of inserting intramedullary nails into the tibial nodule outwards and outwards,design and develop a new type of tibial intramedullary nails suitable for this approach,and place the produced intramedullary nails into the anatomical specimen through the improved outwards and outwards of the tibial nodule,to demonstrate the feasibility of this approach and the practicability of the new type of intramedullary nails.Methods:1.The anatomy of the upper tibia near the knee joint was studied to demonstrate the theoretical basis of tibial intramedullary nail placement through the improved external and superior approach of the tibial tubercle.2.According to the anatomical characteristics of the proximal tibia,a new tibial intramedullary nail was designed and developed,which was suitable for the improved external and upper approach of the tibial nodules.3.The preliminarily produced new tibial intramedullary nail was placed into the anatomical specimen through the modified lateral and superior approach of the tibial tuberosity,and the X-ray was taken after the insertion.Results: 1.Modified external and superior approach of the tibial tubercle to place the intramedullary tibial nail opening was selected on the external and superior side of the tibial tubercle,namely the external upper part of the tibial tubercle,the iliotibial band insertion(Gerdy tubercle),the medial side of the tibial anterior muscle insertion,and the exposed bone area of the lateral patellar ligament as the insertion opening.The internal boundary of the entry point can be determined by touching the tibial tubercle and touching the patellar ligament with the moving knee.The outside of the entry point can be determined by touching the Gerdy tubercle.The entry point is made in the area between the two,which is a bare bone area covered by only a thin layer of soft tissue and is easily touched on the human surface.2.The proximal end of the new intramedullary nail is located anterolateral to the tibia at an oblique Angle,and its outer frame system is anterolateral,so that it does not affect the intraoperative fluoroscopic anterolateral tibia X-ray.In the new operating system,the pressure-bar device,which was originally located in the front,was changed to the front and outside,and the distal locking position was located perpendicular to the anterolateral bone surface of the tibia.During the operation,the new pressure-bar system was not easy to slide,and the distal locking screw was inserted more smoothly.3.Through the improvement of tibial tubercle outside into the road into the new upper tibia intramedullary nail in the process of the main nail end first into the medullary cavity with the Angle of the proximal tibia cortex at least 45 ° above,after the nail into the process from the Angle of slowly into pointing in the direction of long axis of the tibial Angle,in the process of nailing can feel a mild resistance,The intramedullary nail is rotated through the handle to pass through the resistance point;After the insertion of the new type of intramedullary nail,X-ray observation showed that the main nail had a certain Angle on the anteropotential position of the tibia and fibula,while it was straight on the lateral position of the tibia and fibula,which was contrary to the X-ray manifestations after the insertion of the nail through the suprapatellar approach and the suprapatellar approach,and basically consistent with the design concept of the new type of intramedullary nail.Conclusions:1.It is theoretically reasonable to place the tibial intramedullary nail through the outer upper part of the tibial tubercle,the iliotibial band insertion point(Gerdy tubercle),the medial part of the tibial anterior insertion point,and the bony exposed area of the lateral patellar ligament.2.A new type of tibial intramedullary nail was designed and produced,which is suitable for the improved external and superior approach to the tibial tuberculum.This intramedullary nail system is more suitable for clinical application than the traditional intramedullary nail system;3.In the process of nail placement,the Angle of nail placement should be paid attention to,and the intramedullary nail should be rotated inward when the resistance point is encountered.The new tibial intramedullary nail can be safely and effectively placed on the anatomical specimen through the improved lateral and superior approach of the tibial nodules.