Analysis Of Related Factors That Influence The Lower Limb Alignment After Intramedullary Nail Fixation Of Tibial Fracture

Aim:To study the the related factors that influence the intraoperative reduction and postoperative tibial force line in intramedullary nail fixation on tibial fracture.Methods:Retrospective analysis of 94 patients with tibial fractures admitted in the First Affiliated Hospital of Dalian Medical University from January 2012 to December 2015,aged from 18 to 87 years(mean,44.73 ± 48.79 years),including 75 males,Female 19 cases,bilateral tibial fractures in 2 cases,counting two cases each.According to the surgical approach divided into the suprapatellar approach group and the infrapatellar approach group,according the fibula fixation or not divided into fibular fixation group and non-fixed group,and the number of distal locking screws into two screws groups and three screws groups.Fracture classification is divided into type A group,type B group,type C group by AO/OTA classification.Analyse the patient's gender,age,fracture type,postoperative force line of tibial on coronal and sagittal view,the operation time,the amount of bleeding,intraoperative use of auxiliary reduction tool or not,intramedullary nail distal locking number,fracture of fibula and whether the fracture be fixed,hospital days and so on.There was no significant difference between the three groups in A type,B type and C type,but there was statistical significance in the sagittal position.The comparison between the three groups in the sagittal group,only A group and B group was statistically significant(P<0.05),A group and C group,B group and C group had no statistical significance.Results:There was no significant difference in the basic information such as age,length of hospital stay,operation time,blood loss and gender among the groups(P>0.05).There was no significant difference in tibial sagittal force line between fibular fixed group and non-fixed group(P>0.05).There was significant difference in the postoperative tibial coronary force line between fibular group and non-fixed group.(P<0.05)Postoperative tibial coronal force line of fibular fixed group is superior to non-fixed group.There was no significant difference in the postoperative tibial sagittal and coronal line between the two screws group and three screws group.(P>0.05).There was no significant difference in the tibial force line between the suprapatellar group and the infrapatellar group,but only compare the tibial distal and proximal fractures,the postoperative tibial coronary and sagittal force line is statistically significant(P<0.05).The suprapatellar group was superior to the infrapatellar group.There was no significant difference in middle part of tibial fracture in postoperative tibial sagittal and coronary line between the suprapatellar group and the infrapatellar group(P>0.05).CONCLUSIONS:In distal or proximal tibial fractures,the suprapatellar approach is superior to the infrapatellar approach in the recovery and maintenance of the tibial force line.There is no significant difference in the fixation of the fibula in the sagittal view,but the fixation force in the coronal view in fibular fixed group than that in the non-fixed group.The patients with type 42-A fractures of the tibia were found to be relatively well operated on the postoperative alignment.