Clinical value of the closed reduction interlocking intramedullary nail for internal fixation in the treatment of middle and lower tibial fractures

ObjectiveTo investigate the clinical value of closed reduction interlocking intramedullary nails for internal fixation(IMN) in the treatment of the middle and lower tibial fractures, and its effects on the improvement of patient function, inflammatory stress, serum alkaline phosphatase(ALP), osteocalcin N-terminal middle molecule fragment(N-MID), type Ⅰ collagen carboxy-terminal peptide fragment(β-CTX) expression.

MethodsEighty patients with middle and lower tibial fractures were divided into the IMN group(n=40) and control group(n=40) according to the random number table.The control group was treated with open reduction and limited-access steel plate internal fixation, and the IMN group was treated with IMN.The operative conditions, complications, excellent and good rates of ankle joint and knee joint function recovery after 6 months of surgery, serum inflammatory response indexestumor necrosis factor-α(TNF-α), interleukin-8(IL-8) and interleukin-6(IL-6) before surgery, after 1 d and 3 d of surgery, stress response indicatorsnorepinephrine(NE), angiotensin-Ⅱ(Ang-Ⅱ) and cortisol(Cor), and levels of ALP, N-MID and β-CTX before, after 1 week and 1 month of opertaion were compared between two groups.

ResultsThe incision length, postoperative time to ground and fracture healing time in IMN group were shorter than those in control group, and the intraoperative blood loss, postoperative drainage and ratio of midsection diameter of the affected side after 24 h of operation to preoperative diameter in IMN group were lower than those in control group(P < 0.01).The incidence rate of complication in IMN group was 5.00%, which was lower than that in control group(22.50%)(P < 0.05).The serum levels of TNF-α, IL-8, IL-6, NE, Ang-Ⅱ and Cor in two groups after 1 day and 3 days of surgery increased compared with before operation, and which in IMN group were lower than those in control group(P < 0.01).After 1 week and 1 month of surgery, the levels of ALP and N-MID in two groups increased compared with before surgery, and the levels of ALP and N-MID in IMN group were higher than those in control group(P < 0.01).After 1 week and 1 month of surgery, the levels of β-CTX in two groups decreased compared with before surgery, and the level of β-CTX in IMN group was lower than that in control group(P < 0.01).The excellent and good recovery rates of ankle joint and knee joint in IMN group afetr 6 months of operation were 94.87% and 97.44%, respectively, which were higher than those in control group(74.36% and 79.49%)(P < 0.05).

ConclusionsThe application of IMN in the treatment of middle and lower tibia fractures has the advantages of less bleeding, rapid postoperative recovery, fewer complications, good functional recovery, light body's inflammatory stress response and fast recovery of the levels of ALP, N-MID, β-CTX.