RESUMO
Objective To compare the clinical effectiveness of external fixation,expert tibial nail (ETN) and minimally invasive percutaneous plate osteosynthesis (MIPPO) in the treatment of AO type 43A tibial fractures.Methods The clinical data of 102 patients with AO type 43A tibial fracture were retrospectively analyzed who had been treated from June 2010 to June 2014.They were 68 men and 34 women,from 18 to 71 years of age (average,36 years).By AO classification,there were 36 cases of type A1,45 ones of type A2,and 21 ones of type A3.External fixation was used in 30 cases,MIPPO in 42,and ETN in 30.The 3 groups were compared in terms of operation time,blood loss,fracture healing time,complications and functional evaluation according to American Orthopaedic Foot and Ankle Society (AOFAS) criteria for middle and fore foot.Results The operation time in external fixation group (72.7 ± 16.1 min) was significantly less than in MIPPO group (101.5±15.1 min) and ETN group (115.0±11.2 min) (P ＜0.05).The blood loss and fracture healing time in external fixation group were (320.6 ±40.8 mL) and (160.6 ± 25.0 days),significantly greater than in MIPPO group (125.5 ± 27.3 mL and 120.3 ± 20.2 days)and ETN group (124.2±25.4mL and 125.5±25.6 days) (P ＜0.05).The total complication rate in external fixation group (53.3％,16/30) was significantly higher than in MIPPO group (9.5％,4/42) and ETN group (10.0％,3/30) (P ＜ 0.05).The total AOFAS excellent to good rate in external fixation group (66.7％,20/30) was significantly lower than in MIPPO group (88.1％,37/42) and ETN group (90.0％,27/30) (P ＜ 0.05).However,there were no significant differences between MIPPO and ETN groups concerning all the above outcome indicators (P ＞ 0.05).Conclusions For AO type 43A tibial fractures,internal fixation should be the first choice.Both MIPPO and ETN can lead to good clinical efficacy.However,in cases where internal fixation is not suitable,external fixation with distal lateral tibial nails at the Chaput tuberosity can obtain satisfactory ankle function.
RESUMO
Objective To evaluate the clinical effect of vertebra pedical nail strengthened by bone cement.Methods 48 cases with vertebral illness were divided into two groups,each group of 24 cases.One group goes ahead of the restvertebra pedical nail dishpour into viscous polymethyl methacrylate(PMMA),another group fixed by regular vertebra pedical nail.VAS score,spinal stability and JOA score were adopted to evaluate curative effect synthetically.Results After 1 month,6 months,12 months,the VAS scores in the treatment group were(3.12 ± 1.65),(3.08 ±1.10),(3.09 ± 1.25),and the VAS scores in the control group were(4.31 ±2.13),(4.22 ± 1.48),(4.12 ±1.34),the VAS scores had statistically significant differences between the two groups postoperative 1 month,6months,12 months(t =2.15,2.08,1.97,all P＜0.05);after 1 month,6 months,12 months JOA scores in the treatment group were(26.76 ±4.36),(26.78 ±2.10),(26.96 ± 1.89),and JOA scores in the control group were (24.13 ± 5.28),(24.32 ± 1.68),(24.32 ± 1.99),the JOA score differences had statistically significances between the two groups(x2 =5.031,P ＜0.05);the excellent rates of the treatment group was 90.13％,which was higher than 85.01％ of the control group(t =3.54,3.39,3.56,all P ＜ 0.05).Conclusion Patients receiving vertebra pedical nail strengthened by bone cement was better than regular vertebra pedical nail skill.