Comparison Of Clinical Efficacy Of Additional Steel Plate And Replacement Of Intramedullary Nail In The Treatment Of Femoral Shaft Fracture After Fixation With Intramedullary Nail

Background: Intramedullary nailing is one of the main surgical methods to treat femoral shaft fractures in clinical practice.However,with the diversification and complication of injury types and the continuous popularization in clinical application,the incidence of aseptic nonunion of bone after surgery is also on the rise.Objective: This study compared the therapeutic effect of retaining intramedullary nailing with additional steel plate and replacing intramedullary nailing in the treatment of aseptic nonunion of femoral shaft fractures after fixation with intramedullary nailing,and explored the best surgical method.Methods: Retrospective analysis was performed on the patients with aseptic nonunion of bone after intramedullary nail internal fixation of femoral shaft fractures admitted to our hospital from February 2016 to June 2019.The patients were randomly divided into two groups: 30 patients(group A)with intramedullary nail plus steel plate,and 26 patients(group B)with intramedullary nail replacement.Preoperative diagnosis and radiological criteria for bone nonunion by the fda were used to determine whether the patient was complicated with bone nonunion.The bone nonunion was classified according to w-c(weber-cech).After the operation,the patients were comprehensively evaluated according to the function of the affected limb and X-ray findings of the follow-up patients,and the clinical efficacy was evaluated according to the tohner-wrnch standard.Results: All patients were followed up after the operation for 14-26 months,with an average of 17.9 months.There were no statistically significant differences in gender,age,femoral w-h(winquist-hansen)fracture typing,and bone nonunion w-c(weber-cech)typing between the two groups(P>0.05).Operation time and blood loss in group A were less than that in group B,with statistically significant differences(P<0.05).The length of stay was not statistically significant(P>0.05).Both clinical and radiographic bone healing time in group A was earlier than that in group B,and the difference was statistically significant(P<0.05).During the follow-up period,no internal fixation movement or fracture failure,no reloss after fracture reduction,and no adverse events such as angular formation or rotational healing occurred in patients in group A and group B.In the last follow-up,the patients were evaluated according to the tohner-wrnch score criteria.In group A,19 patients were excellent,10 patients were good,and 1 patient was poor,with an excellent and good rate of 96.7%.Group B: excellent 14 cases,good 7 cases,poor 5 cases,excellent and good rate80.8%;The difference between the two groups was statistically significant(P < 0.05).Conclusion:Compared with replacement of intramedullary nailing,retaining intramedullary nailing and adding steel plate in the treatment of femoral shaft fracture after the fixation of intramedullary nailing has the advantages of relatively simple operation and satisfactory clinical efficacy,and is an ideal treatment method.However,high quality,diverse and well-designed prospective studies are needed for further confirmation.