| Objective:This research is based on in-depth study of ample ancient TCM literature on “metal needle bone adjusting” method.The history,status quo and relevant materials of this method are reviewed and summarized so as to lay the foundation for the clinical experiment,which is designed to testify the advantages of this method in the restoration of posterior malleolus fracture.The mappings of Volkmann fracture and posterior Pilon fracture are plotted in accordance with the research methodology.Volkmann fracture is caused by contorting force on the posterior malleolus while posterior Pilon fracture is caused by combined vertical forces.The shapes of posterior malleolus with injuries of these two mechanisms are compared to help discuss the prospects of fracture mappings applicable to clinical restorations.Methods:1.On the basis of ancient TCM literature and modern research findings,this research investigated the material and shapes of ancient needles as well as the course of their changes and developments.The operating procedures and applicability of metal needles in clinic therapies are summarized from related records in medical books throughout history,so as to ensure a deeper understanding of the development and philosophical concept of “metal needle bone adjusting” method.2.The curative effect of “metal needle bone adjusting” method is verified in its application in the restoration of posterior malleolus fractures.60 patients conforming to the inclusion standards are treated by operation and recruited from the in-patient department of the affiliated hospital of Shandong University of TCM.They are randomly divided into the“metal needle bone adjusting” restoration group and the “apparatus”restoration group.The restoration time during the operation was set as the indicator of restoration efficiency.The Burwell-Charnley radiological evaluation standard is adopted to assess the articular surface restoration.The follow-up conditions are assessed by the U.S.AOFAS Ankle Hindfoot Scale3 months after operation to indicate the function of articulations.The efficacy of this needling method is discussed based on inter-group statistical analysis.3.Plotting of the fracture mapping of posterior malleolus involves the following steps: 1 The CT of the ankle joint of a healthy volunteer is used as the reference.2.CTs of 60 patients with posterior malleolus fracture up to the standards are included and divided into Volkmann fracture group(30 cases)and Pilon fracture group(30 cases)according to their respective features.3.Software Mimics Research 21.0 is used to reconstruct the fracture simulations of the posterior malleolus of the volunteer and patients.These simulations are then introduced into the 3-matic 13.0 software and superimposed against each other to generate a map of fracture lines which is projected onto the articular simulation model of the healthy volunteer.Mimics Research 21.0 is used to excerpt the plan of the malleolus of the volunteer and the patient with posterior Pilon fracture.The excerpts are then imported into Adobe Fireworks CS6 to be superimposed to plot the comminution zone and the communition zibe map in the malleolar plan of volunteers.The angle α between bimalleolar axis at axial plane and the fracture line,the angle β of posterior malleolus at the sagittal plane,the fracture area ratio to articular surface(FAR),the fracture height of posterior malleolus fracture fragment(FH),the ratio between anteroposterior diameter of the posterior malleolus fracture fragment and that of the articular surface of distal tibia(APDR),left-to-right diameter ratio between posterior malleolus fracture fragment and articular surface of distal tibia(LRDA).SPSS26.0 is used to analyze the difference between groups.Results:1.Ancient needles include stone needles,bone needles,and thorns from plants.With the development of metallurgy,metal needles made of bronze,iron,gold,and silver,etc were put to clinical use.Doctors in history invented different forms of needles,such as “nine needles” and “knife needles”,in clinical practice.Representative surgical needling methods include “levering”,“piercing”,“cutting” and “pushing”,which were applied to “restoration”,“debridement”,and “draining fluids”.“Metal needle bone adjusting” method is an operation that uses specially designed bone needles or steel needles to insert into the fractured end of the bone,the space of dislocated joints or in between fractured bone pieces,so as to lever,push,to restore the dislocated joints and bone pieces.2.No statistically significant difference(P<0.05)is observed in the“metal needle bone adjusting” group and “apparatus” group according to AOSAF ankle hindfoot scale and the fracture restoration radiological assessment standard(Burwell-Charnley).Difference is observed in the time lengths for operational restoration,with the “metal needle bone adjusting”group having a higher efficiency in restoration(P>0.05).3.3D maps of the fracture lines in the posterior malleolus fragment under two injury mechanisms are plotted and the comminution area map of the posterior pilon fracture is drawn.The average α angle of the Volkmann fracture fragment was 20.29°±6.25°,and the average α angle of the posterior Pilon fracture fragment was 12.37°±8.48°.The comparison between the two angles was statistically significant with the α angle of the posterior pilon fracture fragment being larger(P=0.000).The averageβ angle of the Volkmann fracture fragment was 72.45°±5.28°,and the average β angle of the posterior Pilon fracture fragment was 76.79°±4.38°.The comparison between the two angles was statistically significant,with the β angle of the posterior Pilon fracture fragment being larger(P=0.001).The average height FH of the Volkmann fracture fragment was 0.10mm±5.70 mm,and the average FH of the posterior Pilon fracture fragment was32.19mm±8.51 mm.The comparison between the two heights was statistically significant as the FH of the posterior Pilon fracture fragment was larger(P=0.000).The average FAR of the Volkmann fracture fragment was 8.94%±4.11%,and the average FAR of the posterior Pilon fracture fragment was 8.85%±8.91%.None of the Volkmann fracture fragments had a FAR greater than 25%,while 70%(21 out of 30)of the FAR of posterior Pilon fracture fragments are greater than 25%,with the FAR of posterior pilon fracture being larger.The comparison between the two FARs is statistically significant(P=0.000).The average APDR of volkmann fracture fragment is 26.56%±7.98% and the average APDR of the posterior Pilon fracture fragment is 41.29%±7.02%.The comparison of these two ratios are statistically significant(P=0.00).The average LRFD of volkmann fracture fragment is 36.66%±6.37% and the average LRFD of the posterior Pilon fracture fragment is 9.97% ± 6.79%,The comparison of these two ratios are statistically significant(P=0.00).The comparison between the two is statistically significant(P=0.000)Conclusions:1.“Metal needle bone adjusting” method is a restoration manoeuvre based on lever principle.It can be combined with common physical devices such as kirschner wire and guide pin in a majority of clinical restoration practices.2.The operating facilities are easily accessible,and the method is highly operable.The restoration efficiency is elevated with the quality of restoration maintained,thus optimizing the operational time length and improving on the turnover rate of the operating room.It is worth promoting.3.The fracture parameters with injuries of two mechanisms on the posterior malleolus fracture can be obtained via fracture mapping.The analysis of these parameters can be used as guidance for the restoration of posterior malleolus and provide further support for the application of“metal needle bone adjusting” method to the restoration of posterior Pilon fracture with complex damage mechanism. |
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