| Research background At present,intramedullary nail technology has been widely used in clinical department of orthopedics surgery,effect is quite accurate,However,there is still a chance of failure in the treatment of multiple fractures of the proximal tibia.Scholars at home and abroad have made a more comprehensive explanation of the reasons for the failure of fixed,but there are few reports on the guidance of the second operation.Some scholars believe that since the intramedullary nail fixation failure,then the second operation with steel plate fixation should be the best choice,However,there are many reasons for the failure of intramedullary nailing,many of which are not caused by intramedullary nailing,and there is controversy about whether the intramedullary nail is still effective after reaming.After intramedullary nail fixation failure,therefore,need guidance on remedial treatment,can improve the whole system of intramedullary nail fixation,benefit patients.Objective To investigate the treatment of the fracture of the tibial fractures with intramedullary nailing,and to compare the efficacy of these treatments,and to provide a better basis for diagnosis and treatment of the disease and related basis.Method Retrospective analysis of 25 patients with multiple fractures of the tibia treated with intramedullary nailing in the First Affiliated Hospital of Zhengzhou University from January 2004 to March 2017.All the patients were followed up after the failure of the intramedullary nailing,The average operation rate 1.5 times,There were 14 males and 11 females,aged 20-55 years,with an average age of 36.5 years,with a total of 13 cases in the left side and 12 cases right in the other.All of them were tibial fractures or comminuted fractures after intramedullary nailing.Patients who received the two operation were divided into 2 groups: group A(n = 15),the original intramedullary nail was removed and the double plate fixation was performed;group B(n=10),underwent replacement of a new intramedullary nail.Two groups of patients were treated with bone graft in order to promote fracture healing.The patients were followed up for a long time,and the fracture healing time was observed and recorded,The healing time of A and B two groups of patients were compared with the pathological classification,morphological classification and location of fracture nonunion,so as to evaluate the effect of the two surgical methods.Results The hospitalization time was 14.3±3.5 days,with an average of 12.5 days.All patients were followed up for 6-15 months(an average of 11.3 months),There was no injury or death during follow-up.The fracture healing time was 22.7-48.3 weeks after operation,with an average of 26.9 weeks.Both patients regularly review the X-ray has obvious bone callus formation,existence healing fractures.There was no significant difference in the healing rate of the two kinds of operative methods for hypertrophic nonunion(P>0.05),as for atrophic nonunion,the healing rate of A group was higher than that of B group(P<0.05);When the fracture nonunion occurs in the upper half of the tibia,the healing rate of A group was higher than that of group B(P<0.05),the healing rate of A group was lower than that of group B in the lower half of tibia(P<0.05);There was no significant difference in fracture healing rate between A and B two groups for simple transverse and oblique fractures(P>0.05),However,the healing rate of A group was higher than that of group B with multiple fractures(P<0.05).Conclusions After the failure of intramedullary nail fixation in the treatment of proximal tibial fractures,intramedullary nail can be removed and replaced by double plate fixation,or repalce it with a more appropriate intramedullary nail.However,the different types and locations of the tibial fractures with multiple fractures should be differentiated,We have to take the right subsequent revision surgery to promote fracture healing. |
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