Clinical efficacy of B-ultrasound-guided manual repositioning combined with intramedullary tibial nailing in the treatment of Zhang-Hou fractures

Abstract

Objective:To investigate and analyze the clinical efficacy of B-ultrasound-guided manipulative repositioning combined with tibial intramedullary nailing in the treatment of Zhang-Hou's (Z-H) fractures. Methods: Fifty-nine patients with Z-H fractures treated surgically in our hospital from January 2019 to December 2022 were selected for retrospective study, and were divided into 31 cases in the observation group (B-ultrasound-guided manipulative repositioning combined with intramedullary nailing of the tibia) and 28 cases in the control group (plate screw internal fixation) according to the surgical method. The general data, surgical indexes, VAS scores at 1, 3, 6 and 12 months after surgery, and the excellent rate of functional rehabilitation at 6 and 12 months after surgery were compared between the two groups. Results: There was no statistical difference between the general data of the two groups (P > 0.05), which was comparable. The observation group had better operating time, intraoperative blood loss, number of intraoperative fluoroscopy, hospital stay and fracture healing time than the control group, and the difference was statistically significant (P<0.05). The difference was not statistically significant when comparing the preoperative VAS scores of the two groups (P>0.05); whereas the observation group had better VAS scores than the control group at all postoperative time points, and the difference was statistically significant (P<0.05). The incidence of postoperative complications in the observation group was 6.45% (2/31, cases), which was significantly lower than that in the control group (17.86% (5/28, cases), and the difference was statistically significant (P<0.05). The excellent functional rehabilitation rate in the observation group was 93.55% (29/31, cases) at 12 months after surgery, which was significantly higher than that in the control group (78.57% (22/28, cases), and the difference was statistically significant (P<0.05). Conclusions: Compared with conventional plate and screw internal fixation for Zhang-Hou fractures, B-ultrasound-guided manual repositioning combined with intramedullary nailing of the tibia has the advantages of optimizing surgical indexes, reducing postoperative complications, and improving postoperative functional recovery, and also shortens the learning curve of clinicians for intramedullary nailing surgery.