| Objective:Using Ф 3.5mm Steinmann pin as blocking screw combined with interlocking intramedullary nail in the treatment of lower tibial 1/3 fracture,we collect and analyse the data of fracture healing time,ankle function and complications to discuss the feasibility and clinical effect of surgery. Then it wil provide more guidance for such fracture in clinical treatment. Tibial fracture is more common among long tube bone of the limbs, and accounted for about 10% of the whole body fracture [1]. At present,external fixation,internal fixation with steel plate or intramedullary nail, and fixation with external fixation device are main therapy methods in the clinical. Intramedullary nailing has become a routine method for treating tibial shaft fracture with displacement,which is in accord with new ideas of the biological osteosynthesis(BO). However,because of marrow cavity mismatches with nail, there are malalignment and malformation of enstrophe or exstrophy in the process of treatment. With the emergence of blocking screws(Poller screws) [3],which reduce the width of the medullary cavity,eliminate the mismatching between marrow cavity and intramedullary nail,enhance fixation and mechanical property of intramedullary nail[4],the application of intramedullary nailing is more and more popular. But the position of Poller screw is difficult to determine,the screw may split the bone cortex,destroy the intramedullary nail,damage the nerve and blood vessel.So we use Ф 3.5mm Steinmann pin instead of blocking screw,which reduces the complications of Poller screw and relieves the economic burden of patients at the same time. Then it wil provide more guidance for such fracture in clinical treatment.Methods:Standard of cases selected were as following:1.Patients diagnosed with lower tibial 1/3 fracture,certified by medical history,physical examination,imageological examination.2. Patients used Steinmann pin combined with interlocking intramedullary,who also were able to complete the follow-up.3.Patient was without systemic disease which affected the treatment and curative effect.From July 2010 to February 2014 in Hebei Medical University Third Hospital,there were 15 selected patients in our study,including 13 male and 2 female patients.Average age was 38.9(from 21 to 69 years old).All of them adopted the surgical operation, using Ф 3.5mm Steinmann pin as blocking screw combined with interlocking intramedullary nail,and observed the wond healing,infection, postoperative complications.In order to record the situation of bone healing and displacement,patients must follow up at 1 month,3,6,12 months after operation and examine X-ray.Then we applied AOFAS ankle and hindfoot score and Johner-Wruhs clinical effect evaluation method of tibial fracture to evaluate postoperative function recovery.Anayzed the data by SPSS 13.0 statistical software and the results of measurement data were expressed as the mean±SE.The results of ranked data were dealt with two independent samples nonparametric tests;The significance level α=0.05.Results:①Totally 15 cases have been followed from 9 to 12 months(average 9.6 months) postoperatively. The operation time is 2.67±1.11 hours. In all of the cases, there is no complication after surgery,such as skin necrosis, infection, plants exposed,screw loosening or plate fractured,refracture,nonunion. 12 patients are clinical fracture healing at 3 months after operation and 3 patients still need walking stick who heal at 6 months. The wound healing time is 3.6±1.2 months.②According to AOFAS ankle and hindfoot score, at 3months after operation,excellent in 10 cases,good in 2 cases,poor in 3 cases,no bad case, the excellent and good rate is 80%.③According to Johner-Wruhs clinical effect evaluation method of tibial fracture, at 3 months after operation,excellent in 3 cases,good in 5 cases,poor in 5 cases, bad in 2 case, the excellent and good rate is 53.3%; at 6 months after operation,excellent in 7 cases,good in 6 cases,poor in 2 cases,no bad case, the excellent and good rate is 86.7%; at 9 months after operation,excellent in 9 cases,good in 5 cases,poor in 1 cases,no bad case, the excellent and good rate is 93.3%. There is statistical significance in the excellent and good rate between postoperative 3 months and 6months(P=0.036<0.05);and no significant difference between postoperative 6 months and 9 months(P=0.43>0.05).Conclunsion: We use Ф 3.5mm Steinmann pin as blocking screw combined with interlocking intramedullary nail in the treatment of lower tibial 1/3 fracture and the surgery has a good effect.All paptients get a good functional recovery at 6 months after operation.There is no serious complication after surgery,such as infection,implant loosening or fractured,refracture,nonunion. The clinical healing time of fracture is shorter(3.6±1.2 months) and after review of X-ray,reduction are not lost.The way of operation saves the time and the cost of surgery,reduces the damage to the soft tissue,because it is not necessary to change Steinmann pin into screw which will remove in the future.So it provide some guidance for such fracture in clinical treatment. |
PDF Full Text Request