| Objective: To investigate and compare the clinical efficacy and postoperative complications of the treatment of tibial epiphyseal fracture by intramedullary nail(IMN)and minimally invasive plate internal fixation(MIPO),to evaluate the safety and effectiveness of the two methods in the treatment of tibial epiphyseal fracture,and to provide theoretical basis and reference for the clinical treatment of such fractures.Methods: Part I: Clinical data of 38 patients with proximal tibial epiphyseal fractures who underwent surgical treatment in The Bone Trauma Hospital of Honghui Hospital affiliated to Xi ’an Jiaotong University from January 2015 to January 2021 were included according to inclusion and exclusion criteria.There were 21 males and 17 females.The age ranged from 22-70 years,with an average of 45.7±11.7 years.AO/OTA classification of fracture: 14 cases of 41-A2 type,16 cases of 41-A3 type and 8 cases of 41-C1 type.Causes of injury: motor vehicle collision in 20 cases,fall injury in 11 cases and other causes in 7 cases.20 cases were treated with IMN fixation(IMN group),and 18 cases were treated with steel plate fixation(plate group).The time from injury to operation,intraoperative blood loss,operation time,hospital stay,assisted reduction,fracture healing time,ground loading time,postoperative infection(superficial infection and deep infection)and knee pain were compared between the two groups.The knee range of activity was measured and recorded at the last follow-up,and the limb force line was evaluated by Freedmanand Johnson method according to the imaging data.Johner-Wruhs rating was used to evaluate the efficacy of tibial fracture.Visual Analog Scale(VAS)was used to assess knee pain.Part II: Clinical data of 59 patients with distal tibial metaphyseal fracture who underwent surgical treatment in The Bone Trauma Hospital of Honghui Hospital affiliated to Xi ’an Jiaotong University from January 2015 to January 2021 were included according to inclusion and exclusion criteria.There were 30 males and 29 females.The age ranged from 23-70 years,with an average of 47.5±12.4 years.AO/OTA classification of fracture:9 cases of 43-A1 type,26 cases of 43-A2 type,17 cases of 43-A3 type and 7 cases of43-C1 type.Causes of injury: motor vehicle collision in 31 cases,fall injury in 17 cases and other causes in 11 cases.33 cases were treated with IMN fixation(IMN group)and26 cases were treated with steel plate fixation(plate group).The time from injury to surgery,intraoperative blood loss,operative time,hospital stay,assisted reduction,fracture healing time,ground loading time,postoperative infection,skin necrosis,fracture nonunion,ankle pain and knee pain were compared between the two groups.At the last follow-up,the Freedmanand Johnson method was used to evaluate the limb force line combined with imaging data.Johner-Wruhs rating was used to evaluate clinical outcomes.Ankle function was evaluated by the American Orthopaedic Foot and Ankle Society(AOFAS)scale.Ankle pain was assessed by visual analog scale(VAS).Results: Part I: All patients were followed up for 12-36 months,with an average of24.9±6.1 months.There were no statistically significant differences between the two groups in the time from injury to surgery,intraoperative blood loss,operation time,assisted reduction,knee pain,postoperative infection,and limb force line(P > 0.05).The last Johner-Wruhs tibial function rating in IMN group was excellent in 14 cases,good in4 cases,fair in 1 case and poor in 1 case,with an excellent and good rate of [90%(18/20)].The last Johner-Wruhs tibial function rating in steel plate group was excellent in12 cases,good in 3 cases,fair in 1 case and poor in 2 cases,with an excellent and good rate of [83.3%(15/18)],and the difference had no statistical significance(P > 0.05);The range of motion of knee joint in IMN group [(117.5 ± 4.3)°] was higher than that in steel plate group [(115.7 ± 4.6)°],and there was no significant difference(P > 0.05);The hospitalization time,fracture healing time and weight-bearing time in IMN group were shorter than those in steel plate group(P < 0.05).Part II: All patients were followed up for 12-36 months,with an average of 24.6±6.0months.There were no statistically significant differences in intraoperative blood loss,operation time,assisted reduction,fibula fixation,ankle pain,postoperative infection,limb force line,fracture nonunion and skin necrosis between the two groups(P >0.05).The last Johner-Wruhs tibial function rating in IMN group was excellent in 25 cases,good in 5 cases,fair in 2 cases and poor in 1 case,and the excellent and good rate was [90.9%(30/33)].The last Johner-Wruhs tibial function rating in steel plate group was excellent in 17 cases,good in 5 cases,fair in 2 cases and poor in 2 cases,and the excellent and good rate was [84.6%(22/26)];The ankle AOFAS score of IMN group was[(92.1 ± 6.9)points],and that of steel plate group was [(90.2 ± 6.3)points];The excellent and good rate of ankle function in IMN group was [93.9%(31/33)],and that in steel plate group was [92.3%(24/26)],there was no significant difference(P > 0.05).There were significant differences between the two groups in the time from injury to operation,hospital stay,fracture healing time,weight-bearing time and knee pain(P < 0.05).Conclusion: Both methods can achieve satisfactory clinical efficacy,have similar therapeutic effects in functional results and complications,and can safely and effectively treat tibial metaphyseal fractures.Research shows that in the proximal tibial metaphyseal fracture,IMN group has the advantages of short hospital stay,short fracture healing time and early weight-bearing time.However,the incidence of knee pain in IMN treatment of distal tibial metaphyseal fracture is significantly higher than that in plate treatment,but the time from injury to operation,hospital stay,fracture healing time and weight-bearing time are shorter than those in plate group,which has certain advantages. |
PDF Full Text Request