| Objective: To investigate the efficacy of semiextended positioning intramedullary nailing combined with hollow screw fixation in the treatment of spiral fracture of the distal third of the tibia combined with posterior ankle fracture. Methods: The clinical data of 60 patients with spiral fracture of the distal third of the tibia combined with posterior ankle fracture admitted to Chuzhou Integrated Traditional Chinese and Western Medicine Hospital Affiliated to Anhui University of Traditional Chinese Medicine from October 2016 to June 2020 was analyzed retrospectively, including 47 males and 13 females, aged 18 ~ 71 years old, with an average age of (53.15±4.06) years old. Causes of injury: traffic accident injuries with 27 cases, fall with 21 cases, and sports injury with 12 cases. According to the different methods of intramedullary nailing, the patients were divided into two groups, the semiextended group was fixed with semiextended positioning intramedullary nailing combined with hollow screw fixation (30 cases), and the standard group was fixed with standard intramedullary nailing combined with hollow screw fixation (30 cases). All patients were followed up for 1 year after surgery. The operative time, intraoperative blood loss, fracture healing time, ankle function, knee function, pain degree and complications were compared between the two groups. Results: The operative time in the semiextended group was shorter than that in the standard group (P < 0.05). There were no significant differences in intraoperative blood loss, and fracture healing time between the two groups (P > 0.05). After surgery, the American Association of foot and ankle surgery (AOFAS) score, Karlsson ankle function (KAFS) score and Hospital for Special Surgery (HSS) score in both groups increased gradually (P < 0.05), and the Visual analogue scale (VAS) score decreased gradually (P < 0.05). The VAS score at 12 weeks after surgery and at 1 year after surgery in the semiextended group were lower than those in the standard group (P < 0.05), HSS score was higher than standard group (P < 0.05). There was no statistical difference in the incidence rate of complications between the two groups (P > 0.05). Conclusion: The patients with spiral fracture of the distal third of the tibia combined with posterior ankle fracture are treated with semiextended positioning intramedullary nailing combined with hollow screw fixation, compared with the standard intramedullary nailing combined with hollow screw fixation, the safety and effect of promoting ankle joint recovery are equivalent, and the operation time is shorter, the postoperative pain is lighter, the improvement of knee function was more obvious and has more advantages in the treatment. |
