| Objective: In recent years,due to the increase in transportation and the speed of the car accelerated,the high level of violent injury caused by car accident is on the rise.Among them,tibial shaft fracture is one of the most common long bone fractures,which account for about 13.7% of total fractures.Because of the particularity of its location and local anatomy,the treatment of tibial shaft fracture is diverse.It is mainly divided into conservative treatment and surgical treatment,and the main methods of surgical treatment are intramedullary fixation,plate and screw fixation,screw fixation and external fixation.In recent years,the concept of "minimally invasive" and “BO”have been put forward and developed,intramedullary fixation is increasingly valued by clinicians,and its high healing rate and tiny trauma have been widely recognized by clinicians.Yet there is still a great difference between endodontic and intramedullary endodontic expansion.Some experts believe that expand the pulp not only can be implanted into the main nail of the larger diameter,increase the contact area,stabilize the fracture end,resist the bending ability,and avoid the fracture of internal fixation,but also the bone fragments can form internal bone grafts and increase the healing of fracture.While others hold the opinion that it can damage the blood transport and reduce the blood flow of the bone,which will increase the probability of non-union and bone necrosis.In view of this divergence,we evaluated the clinical effect of the treatment of tibial shaft fracture with the expansion of the spinal cord and non-reaming.Methods: Through a retrospective analysis of 42 patients with tibial shaft fracture treated by surgery in Hebei General Hospital from September2015 to September 2016.There were 29 males and 13 females,and according to the AO classification,there were 7 segments,22 middle segments and 13 lower segments.Divided the 42 patients into 22 patients with enlarged spinal cord and 20 patients with non-enlarged spinal cord.All patients were prepared before the surgery,excluding the contraindications,and the operation was performed under continuous epidural anesthesia.Expanding medullary group: The operation was applied to expand the medullary cavity after expanding the medullary cavity,until the medulla appears the bone cortex rub.Then the intramedullary nail with diameter of 1-1.15 mm diameter was selected.Non-expanding group: The diameter of the intramedullary nail of the medullary cavity was selected after the operation of the tibial medullary cavity.Specific surgical methods:(1)Expanding medullary group: take continuous epidural anaesthesia,after the anesthetic effect,the treatment area iodine,alcohol disinfection,the sterility sheet.The skin,subcutaneous tissue and patellar ligament were incised by the patellar ligament,and the lower slope of the tibial plateau was touched,and the insertion point was determined.Apply the taper tap to open the cortex.Under the C arm fluoroscopy,reduction of fracture end reset after a successful start application expanding medullary enlarge pulp,began to enlarge pulp,minimum diameter expanding pulp bit until a "bone cortex tremor",select the small diameter expanding medullary intramedullary nail placement of1-1.5 mm.After the completion of intramedullary nail placement,the c-arm was used to determine the depth of intramedullary nailing and the degree of fracture reduction,and the "full circle technique" was applied to lock the proximal end and distal locking nail.Install intramedullary nailing cap and suture by layer.Make the incision with sterile dressing.(2)Non-enlarged group: a continuous epidural anesthesia was used,and sterile sheets were given after success.The skin and subcutaneous tissue were separated by thepatellar ligament,and the medial line of the patellar ligament was divided into the patellar ligament,until the insertion point was determined.Use the tip of the cone to open the needle point and expand the cortex.In the X-ray fluoroscopy,the fracture was restored,and the diameter of the intramedullary nail was selected in advance,and the intramedullary cavity was inserted along the insertion point,and the fracture was extended to the distal end.Lock the distal end and the proximal locking pin firmly.Install the tail cap.Flush with a large amount of salt water and suture the wound layer by layer.Postoperative treatment: Both groups received the same medication and postoperative rehabilitation function.Statistical analysis: Data from both groups and observations were used using SPSS 17.0 software for statistical calculation.The measurement data were expressed as((34)± s),and independent sample T test was adopted between the two groups of data.(34)The counting data was expressed as percentage,compared with chi-square test,P < 0.05 The differences were statistically significant.Results: 1.The operation time and blood volume of the patients with enlarged spinal cord were significantly higher than those in the non-medullary group(P < 0.05);2.The fracture healing time was shorter than that in the non-reamed group,and the difference was statistically significant(P < 0.05).Expanding group of intramedullary nail bar and the failure rate of 0,locking nail in patients without expanding medullary group found 1 case of intramedullary nailing main rod failure,4 cases were found loose locking nail,wait for a phenomenon,the difference between the two groups statistically significant(P < 0.05).3,two groups of patients were not present with the upper fascia chamber syndrome and complications such as pulmonary embolism,in superficial soft tissue infections in 3,expanding medullary group in 2 cases,the expansion of pulp group in 1 case,not yet a deep soft tissue infection andosteomyelitis.There was no significant difference in postoperative complications between the two groups(P > 0.05).Conclusion: Tibial stem fracture is the most common long bone fracture.Though the most important treatment is intramedullary nail fixation by far,it remains controversial whether or not it expands.From the above,we can come to the conclusion that reamed interlocking intramedullary nail has the advantage of high fracture healing rate and low inefficiencies in the internal material,but the time of operation and the hemorrhage in the book are significantly increased.Therefore,intramedullary nailing can be used in the young patients with large demand for the expansion of intramedullary nail,which can help to promote the early reduction of the weight of young people and fracture healing and reduce internal fixation failure.The expansion type intramedullary nail needs shorter operation time,blood loss.As for elderly patients who are not well in surgery tolerance,the use of intramedullary nail can reduce the operation time and intraoperative bleeding,and thus reduce the risk of surgery and anesthesia.Therefore,different tibial shaft fractures were fixed with appropriate types of intramedullary nails according to different patients. |
