Clinical Analysis And Comparison Of Intramedullary Nail Through Traditional And Suprapatellar Approach For Proximal Tibial Fractures

Objective Comparison of intramedullary nail through traditional and suprapatellar approachl in the treatment of proximal tibial fractures, including fracture reduction accuracy, knee joint function, bone healing time and radiological results. Methods From January 2012 to November 2012, a total of 46 cases with proximal tibial fractures were included. According to the surgical management, the patients can be divided into control group(23 cases with traditional patellar approach intramedullary naiingl) and treatment group(23 cases with a new type of META- NAIL patellar approach intramedullary nailing). Comparing of operation time, hospitalization time, bone healing time and using CT imaging to compare the postoperative coronary and sagittal axis angle and shortening. All the patients were received closed reduction, and the antibiotic use was 24 h postoperatively in patients with closed fracture. For open fractures, antibiotic use was 3 ~ 5 days after debridement. Appropriate use of dehydration drugs, with swelling subsided after surgery. For patients with tension blisters, static drop of the dehydration drug with infiltration of the magnesium sulfate solution gauze covering crus. Surgical treatment was carried out after the blisters subsided. The postoperative antibiotics use in patients with internal fixation was more than 72 h, and CPM training began at 2 d postoperatively in order to early recovery knee joint function, at the same time preventing vein thrombosis of lower limbs.Results All 46 cases have been followed up, and the average duration of follow-up was14 ± 3.5 months(11 ~ 18 months). All incision were healing well. CT examination were performed after surgery, by measuring the tip after two groups of patients with postoperative coronary position Angle(3.6 ° in the control group plus or minus 2.8 °,the treatment group 3.8 ° ± 2.4 °), sagittal position shift(1.0 ± 3.4 mm in the controlgroup, treatment group 1.2 ± 4.5 mm) and coronary position shift(1.3 ± 5.6 mm in the control group, treatment group 1.1 ± 3.9 mm) there was no significant difference(P >0.05). Experimental sagittal angle(the control group to 4.9 ° + 3.3 °, the treatment group 2.5 ° ± 1.6 °), and the shortening of the limbs(1.3 ± 5.6 mm in the control group,treatment group 1.1 ± 3.9 mm) smaller than in the control group(P < 0.05). The operation time, hospitalization time, bone healing time between two groups had no significant difference(P > 0.05). The Rasmussen knee functional score standard was used to assess the clinical effect, including pain, walking ability, and 5 items of knee joint mobility and stability. Optimal 27 points, or a good 20 ~ 26 points, 10 to 19 points,6 ~ 9 points. Compared with the control group, good rate in the treatment group was significantly higher( 91.3% vs 78.3%, P < 0.05). Statistical processing using SPSS12.0software, said the count data to rate between group compared with X2 test, measurement data with mean ± standard deviation(x + s) said, is compared between group t test. P <0.05 for the difference was statistically significant. Conclusions In this study, we compared the traditional intramedullary nail and patellar approach of intramedullary nail in the treatment of proximal tibial fracture, the result shows that the two groups of patients with postoperative coronary angulation, sagittal position shift and coronary position shift had no significant difference(P > 0.05). The treatment group sagittal angle and limb shortening were smaller than those in the control group, the difference was statistically significant(P < 0.05), and this was just confirmed in patellar approach on the advantage of intramedullary nail. There was significant difference in experimental fracture healing time, which was significantly shorter than the control group(P < 0.05),explaining in actual application, both are able to obtain satisfactory result of fracture healing. Experimental knee joint function was 91.3%, significantly higher than 78.3%in the control group, the difference was statistically significant(P < 0.05). Due to the uniqueness of its design, the META- NAIL patellar approach intramedullary nail ahieved fewer complications, such as patients’ compliance and good tolerance, and the satisfaction rate is higher. It may be not present deep infection, although the two groups of lower extremity deep vein thrombosis, internal fixation failure complications.Thus,compared with traditional intramedullary nailing, the suprapatellar approach intramedullary nailing has the existence of certain advantages. Although the differences in sagittal angle and limb shortening between two groups are statistically significant, it did not affect the bone healing time during follow-up observations(that is, the two groups have been satisfied with the bone healing), but if in a follow-up study to further enlarge the sample size and a longer follow-up period, this kind of influence is still exists(that is, the sagittal Angle and limb shortening differences lead to differences in bone healing), still needs further observation. From the clinical point of view, a satisfactory reduction as much as possible is still the initial purpose that the physicians seek. To sum up, for the treatment of the proximal tibial fractures, suprapatellar approach on intramedullary nail as a relatively new intramedullary fixation devices,curative effect is satisfied, and is worth promoting.