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| Comparative Study on the Effect of Different Approaches of Intramedullary Nail Internal Fixation in Tibial Fractures |
| SUN Bin, LIU Jinlian, LIU Zhengyu, et al |
| Suzhou Kowloon Hospital, Jiangsu Suzhou 215000, China |
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Abstract Objective: To explore the effects of different approaches of intramedullary nailing on complications, bone markers and prognosis of patients with tibial fracture, in order to find a safer and effective treatment. Methods: A retrospective analysis of the clinical data of 125 tibial fracture patients in our hospital from February 2018 to February 2020 was divided into suprapatellar group (n=63) and transpatellar ligament group (n=62) according to different treatment plans. The transpatellar ligament group was fixed with intramedullary nail via the transpatellar ligament approach, and the suprapatellar approach was adopted for the suprapatellar group. The perioperative indicators and complications of the two groups were compared with the inflammatory factors [Interleukin-1β (IL-1β) and C-reactive protein (C-reactive protein, CRP) before and 1 d and 3 d after the operation)], tumor necrosis factor-α (Tumor necrosis factor-α, TNF-α)], bone markers [osteocalcin (BGP), calcitonin (Calcitonin, CT), Total Nterminal propeptide of type I procollagen (Total-PINP), β-C-terminal telopeptide of type I collagen (β-CTX)] levels , Knee motion (maximum angle of knee flexion and extension) before operation, 3 months after operation, 6 months after operation, 12 months, American Special Surgery Hospital (HSS) scoring system, Johner-Wruhs scoring standard (Johner wruhs scoring system, Johner-Wruhs) scoring. Results: The fracture healing time of the suprapatellar group was shorter than that of the transpatellar ligament group, and the number of intraoperative fluoroscopy and the 3 d visual analogue scale (VAS) scores were lower than those of the transpatellar ligament group (P<0.05). The levels of serum IL-1β, CRP, TNF-α and Total-PINP and β-CTX levels in the suprapatellar group at 1 and 3 days after operation were lower than those in the transpatellar ligament group at 2 and 4 weeks after operation. The levels of serum BGP and CT at 2 and 4 weeks after operation were higher than those in the transpatellar ligament group (P<0.05). The postoperative complication rate in the suprapatellar group was 7.94%, which was lower than 22.58% in the transpatellar ligament group (P<0.05). The maximum angles of knee flexion and extension in the suprapatellar group were higher than those in the transpatellar ligament group at 3 months, 6 months, and 12 months after surgery. HSS and Johner-Wruhs scores were higher than those in the transpatellar ligament group (P<0.05). Conclusion: The suprapatella approach intramedullary nail internal fixation for tibial fractures can reduce postoperative pain, promote the improvement of bony markers and fracture healing, improve the range of motion, knee function and clinical function of the knee joint, and reduce complications. In addition, the body's inflammatory response is mild, and the overall effect is better than that of transpatellar ligament approach surgery.
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2021, Vol. 27 
