| The research background:Spiral fractures of the lower and middle tibia are relatively common fractures of the lower extremity.With the deepening of understanding and the continuous improvement of examination methods,the special compound fractures with combined ankle fractures are becoming more and more well known.Due to the characteristics of the bony anatomical structure in the middle and lower segments of the tibia,less soft tissue coverage,and poor blood flow,fractures can easily lead to skin necrosis at the fracture site,delayed bone healing,and nonunion.Therefore,in the process of treating such fractures,effectively protecting blood flow at the fracture end and reducing damage to soft tissues and periosteum are the keys to improving the clinical treatment effect.The ankle joint is directly related to the movement of the lower limbs and is an important weight-bearing joint in the human body.Among the types of ankle fractures,the fracture of the hind ankle is also a more serious fracture type.When the hind ankle fractures,the stability of the ankle joint is no longer maintained.Degeneration of cartilage in the joints also occurs,so it is easy to cause traumatic arthritis.Plate and intramedullary needle fixation are two commonly used internal fixation methods for the treatment of middle and lower tibial fractures,but combined with thespecial type of composite fractures of the posterior ankle fracture,different orthopaedic surgeons have different treatment standards.In this article,we retrospectively analyze the treatment of patients with middle and lower tibial spiral and posterior ankle fractures treated in the undergraduate department,and explore the efficacy of interlocking intramedullary needles combined with cannulated screws or steel plates in the treatment of such composite fractures in order to give some treatment in the clinic Suggest.Materials and Methods:This article retrospectively analyzed 107 patients with spiral fractures of the middle and lower tibia treated in the treatment group of the Department of Traumatology and Orthopaedics,China-Japan Union Hospital Of Jilin Universtity from July 2017 to November 2019.Among them,a total of 37 cases with posterior malleolus fracture All patients were randomly divided into two groups,A and B.Group A was treated with intramedullary needles combined with steel plates.There were 8males and 11 females,aged between 20 and 73 years,with an average age of(38.26 ±13.22)years of age..Group B was treated with pure steel plate,11 males and 7 females,aged between 22 and 71 years old,with an average age of(39.21 ±14.22)years old.Z-H classification was mainly used,in which group A: 10 cases of type Z-H II,5 cases of type III,4cases of type IV;group B: 9 cases of type Z-H II,5 cases of type III,and4 cases of type IV.Improve all auxiliary examinations before surgery,raise the affected limb and apply dehydration drugs to promote swelling.Oral rivaroxaban was given to patients in bed to prevent venous thrombosis after operation.Routine anti-inflammatory,swelling,dressing change every other day and necessary daily functional exercise were given routinely.Detailed recordsof the patient's perioperative and postoperative follow-up case data,as well as postoperative ankle motion,were performed using the AOFAS ankle-hindfoot scoring system to score the ankle function.All follow-up patient data were SPSS 23.0(US IBM)Statistical software was used for processing analysis.Results:All cases were followed up for an average of 18 months.A comparison of the follow-up results showed that there were no wound infections or internal fixation loosening in the two groups.Two cases of skin necrosis occurred in the steel plate group,one had delayed healing of the fracture,and the intramedullary Two cases of knee pain occurred in the needle group;the length of the incision,intraoperative bleeding,postoperative drainage and fracture healing time were shorter in the intramedullary needle group than in the steel group,and the operation time of the steel group was shorter than that in the intramedullary needle group.The differences between the two groups were statistically significant(P <0.05);at the last follow-up,there was no significant difference in flexion and extension of the ankle joint,varus activity,and ankle function scores(P> 0.05).Conclusion:According to this study,it can be concluded that although steel plate internal fixation is the traditional surgical fixation method for the treatment of middle and lower tibial fractures,its operation is simple,the surgical field is clearly exposed,and it can provide more accurate reduction than the intramedullary needle.It is necessary to fully expose the fracture stump,which damages the surrounding soft tissues of the fracture site to a large extent,destroys the blood flow around the fracture,and greatly increases complications such as local skin necrosis,delayedor non-union of the fracture.Risk,and its applicability to patients with poor compliance or with soft tissue injuries and defects.Compared with the steel plate group,the intramedullary needle combined with cannulated screws or steel plates for the treatment of posterior and ankle fractures of the middle and lower tibia,not only guarantees the function and stability of the ankle joint,but also because the intramedullary needle has a small surgical incision and intraoperative blood loss.It has the advantages of fewer fractures and shorter healing time,and minimizes periosteal and soft tissue damage to the fracture site,which reduces the risk of skin necrosis and nonunion after surgery.It can be considered as a treatment for middle and lower tibial fractures with posterior ankle fractures.A better surgical method. |
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