| Objective:To compare the clinical efficacy of Elastic Locking Intramedullary Nail(ELIN)and Minimal Invasive Percutaneous Plateosteosynthesis(MIPP)in the treatment of fibula fractures.Select cases based on inclusion and exclusion criteria,analyze and organize clinical data,compare the advantages and disadvantages of the two surgical methods,and provide a reference for the clinical treatment of fibula fractures,with a view to obtaining better clinical treatment results.Methods:A retrospective analysis of 32 patients with fibula fractures admitted to the Department of Orthopaedics,the Fourth Center Clinical College of Tianjin Medical University and Tianjin Binhai Traditional Chinese Medicine Hospital from January2007 to September 2019.Resilient elastic locking intramedullary nails and minimally invasive steel plates were used for fixation,respectively,and grouped according to the surgical method.Elastic locking intramedullary nails(group A): 13 cases,including 8males and 5 females,aged 17-77 years,average 43 ± 16.7 years old,the injury location is divided into group A,8 cases of left fractures,5 cases of right fractures,including 4 cases of direct violent injury,car accident injury,9 cases of indirect injury,fall injury and fall injury from high altitude.According to A0 score,there were 1 case of type A1,7 cases of type A2,2 cases of type A3,1 case of type B1,1 case of type B3,and 1 case of type C3.Minimally invasive steel plate group(group B): 19 cases,15 males and 4 females,aged 23-80 years old,average age 48.4±16.9 years old,12 cases of left side fractures and 7 cases of right side fractures were classified according to the location of fracture injury.4 cases of direct violent injuries were caused by car accident injuries and blunt device injuries;11 cases of indirect injuries were high-altitude fall injuries and fall injuries.AO classification,A1 type 3 cases,A2 type6 cases,A3 type 2 cases,C1 type 2 cases,1 case of type C3.All patients had no surgical contraindications after preoperative evaluation and perioperative preparation,and received elastic locking intramedullary nails or minimally invasive percutaneous plate treatment.The preoperative AOFAS scores,waiting time for surgery,averagetime for surgery,intraoperative blood loss,number of intraoperative C-arm projections,clinical fracture healing time,postoperative ankle AOFAS score(at last follow-up)and postoperative complications were counted.The standard of clinical fracture healing time is based on the fact that the patient’s limb can fully bear weight,and the X-ray indicates that the fracture line is blurred or disappears;the follow-up time is 1 year.Results:There were 13 cases in group A,8 males and 5 females,aged 17-77 years,with an average age of 43±16.7 years.Group B 19 cases,15 males,4 females,aged 23-80 years,with an average age of 48.4±16.9 years old.There was no difference in gender and age between the two groups(P>0.05).Comparison of observation indexes between group A and group B: length of hospital stay before surgery(group A 4.46±0.87 days,group B 9.05±3.64 days),the comparison between the two groups was statistically significant(P <0.05),Group A has a shorter waiting time than group B;average operation time(27.92±7.20 minutes in group A,126.43±13.40 minutes in group B),the two groups were statistically significant(P <0.05),the operation time in group A was shorter than group B;the average intraoperative blood loss(A Group32.31 ± 7.85 ml,Group B 195.26 ± 28.36ml),the two groups were statistically significant(P <0.05),group A had less intraoperative blood loss than group B;intraoperative C-arm projections(group A 10.23±1.64 times,group B 5.05±2.25times),the two groups were statistically significant(P <0.05),group A had more exposures than group B;the average time to remove the thread(group A 14.46 ±1.12 days,group B 16.63±1.98 days),the difference between the two groups was statistically significant(P <0.05),the average time of stitch removal in group A was shorter than that in group B;the average time to healing(group A 2.35±0.14 months,group B 2.93±0.1 months),two There was no statistical difference between the two groups(P> 0.05);AOFAS score of group A was 89.38±1.66 points,standard score excellent rate was 100%,group B AOFAS score was 90.10±2.0 points,standard rate excellent rate was 100%,There was no statistical difference between the two groups(P> 0.05);In group A,there were 0 patients with postoperative infection,0 cases of delayed healing,0 cases of deformity healing,1 cases of traumatic arthritis,and nointernal fixation fracture and vein were found Thrombosis,knee and ankle pain complications.In group B,there were 0 patients with postoperative infection,0 cases of delayed healing,0 cases of deformity healing,and 2 cases of traumatic arthritis(mainly from tibial side articular surface injury,non-fibula side).No internal fixation fracture,venous thrombosis,Knee and ankle pain complications.The incidence of complications in the two groups was 7.7% and 10.5%,respectively.Conclusion:Both elastic locking intramedullary nails and minimally invasive steel plates are effective methods for minimally invasive treatment of fibula fractures.Compared with minimally invasive percutaneous plate,elastic locking intramedullary nail has the advantages of simple operation,minimally invasive,less intraoperative bleeding,shorter healing time and fewer complications,which is worth clinical promotion. |
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