锁骨骨折不同治疗方法疗效的分析

目的对临床常用的锁骨骨折治疗方法的操作及疗效进行分析,寻求最佳的治疗方法用于临床推广;方法以我院2008年2月-2012年2月治疗的58例锁骨骨折患者为研究对象,将患者随机分为两组,一组患者29例,分别使用克氏针内固定,重建钢板固定,记忆合金固定,锁骨钩钢板固定等方法进行治疗,为手术治疗组;一组患者29例,使用8字绷带固定,为非手术治疗组。对两组及不同手术固定方法的患者的临床疗效,术后患者的生活质量等临床数据进行比较;结果在临床疗效的比较中手术治疗组的患者均无显著差异性,非手术治疗对于骨折移位小及复位后稳定患者具有较好的疗效;在生活质量的比较中重建钢板固定,锁骨钩钢板固定,记忆合金固定患者明显高于克氏针内针固定的患者。结论在锁骨骨折的治疗中应根据患者的具体情况进行相应方法的选择,只有选择科学合理的方法,才能确保治疗的效果及患者的生活质量。

Multilevel cervical spondylotic myelopathy treated by anterior cervical decompression in subsection and autograft fusion

Objective：To investigate a novel surgical method for multilevel cervical spondylotic myelopathy （CSM）. Methods： Totally 21 patients with multilevel CSM undergoing a novel surgical procedure from April 2001 to January 2004 were analyzed retrospectively. All patients experienced anterior cervical decompression surgery in subsection, autograft fusion and internal fixation. Preoperative, immediate postoperative and follow-up image data, X-rays and semi-quantitative Japanese orthopaedics association （JOA） scores were used to evaluate the restoration of lordosis （Cobb＇s angle）, intervertebral heights, the stability of the cervical spine and the improvement of neurological impairment. Results： Preoperative symptoms were markedly alleviated or disappeared in most of the patients. According to the JOA scores, the ratio of improvement in neurological function was 72. 2%, including excellent in 9 cases （42.9%）, good in 7 cases （33.3%）, fair in 3 cases （14.3%） and poor in 2 cases （9.5%）. Immediate postoperative X-rays showed obvious improvements in lordosis and in the intervertebral height of the cervical spine （P〈0. 01）. There is no evidence of instrument failure during the mean follow-up period of 14. 2 months （9-24 months, P〉0. 01）. Conclusion：Anterior cervical decompression in subsection, autograft fusion and internal fixation is a rational effective method for the surgical treatment of multilevel CSM.

Efficacy of Spinal Pia Mater Incision and Laminoplasty Combined with Internal Fixation for Old Spinal Cord Injury

Objective To evaluate the clinical efficacy of incising spinal pia mater to relieve pressure and unilateral open-door laminoplasty with internal screw fixation for treatment of the dated spinal cord injury. Methods From March, 2009 to July, 2010, 16 cases with chronic cervical cord injury underwent spinal dura mater incision and unilateral open-door laminoplasty with internal screw fixation. Nerve functions of preand postoperation were evaluated by Frankel classification and the Japanese Orthopaedic Association (JOA) scale. The improvement rate of JOA score at the indicated time was recorded. Results Postoperative Frankel classification rating of 16 patients improved obviously. JOA scores at the 1st month, 3rd month, 6th month, and 12th month after surgery were 7.9±2.3, 8.5±1.6, 8.9±2.1, and 12.4±2.5, respectively, and significantly increased compared with that prior to surgery (5.5±0.6). At the end of follow-up period, JOA score was significantly higher than that of pre-treatment (P<0.05). The recovery was relatively rapid during the first 3 months following the surgery, then entered a platform period. Conclusion It is effective for patients with dated spinal cord injury to undergo spinal decompression and laminoplasty.

THE TREATMENT OF LUMBOSACRAL INSTABILITY BY THE DIAPASON SYSTEM

Objective. To introduce a new internal fixation system of spine and its characteristics. Methods. To review 16 patients with lumbosacral instability who were treated by this new technique, including their clinical outcomes and radiographic evaluation. Results. Fifteen patients gained complete recovery from their preoperative symptoms. One patient who had experienced two operations before and with problems of urinary and fecal incontinence and walking difficulty still had lower limb pain, muscle weakness and urinary incontinence after operation.There is no evidence of spine glide on X-ray, implant failure, neural complication or infection during follow up. Conclusion. Diapason system can achieve good early postoperative results with few complications and ease to use for lumbosacral instability.

THE DISTRACTION REDUCTION FIXATION SYSTEM AND ITS APPLICATION IN SPONDYLOLISTHESIS

Objective． An internal fixation apparatus—— distraction reduction fixation system(DRFS) was designed to satisfy the clinical needs for spondylolisthesis. Methods. Since 1996, 53 patients were treated with DRFS. Among them, 35 had spondylolisthesis, 12 had lumbar canal stenosis accompanied with instability, 2 had vertebral tumors and 4 suffered from spinal fracture. The average age was 53.6 years old (ranged 24～ 72yrs). The mean time for follow- up was 30.6 months (16～ 44 months). Results． The slip rate was 0.15± 0.10 before operation, and decreased to 0.09± 0.07 after operation. Entire slip reposition was achieved in 19 cases (54.3％ ). The change in height of the intervertebral space within the fixation segments was 0.7± 0.17. Conclusion． DRFS achieved better results for spondylolisthesis less II degree and no other adverse effects were found. Compared with other foreign and domestic techniques, it had advantages in less implants, less operation gears required and ease to utilize in operation. It was proved to be an ideal internal fixation apparatus.

CHANGES IN AIRWAY SPACE FOLLOWING MANDIBULAR SETBACK USING SAGITTAL SPLIT OSTEOTOMY AND RIGID INTERNAL FIXATION

The changes in airway space following mandibular setback using sagittal split osteotomy and rigid internal fixation were studied in 28 Japanese patients with mandibular prognathism. The correlation between the amount of mandibular setback and airway space changes,as well as the correlation between the amount of airway space changes and relapse of pognion point during the following-up period were also studied. Lateral cephalometric radiographs were taken immediately before and shortly after surgery as well as 5 to 12 months postoperation. The cephalometric evaluations of airway space width and area were based on stable craniofacial landmarks. The mean setback of mandible was 8.3 mm in the right side,and 8. 2 mm in the left side. The mean amount of relapse of pogonion point during the following-up period was 0. 52 mm horizontally,and 0. 92 mm vertically. A significant decrease in airway space width and area,especially in the lower part of airway space was found following mandibular setback shortly after surgery. Although there was some increase both in airway space width and area during the following-up period,they did not increase to their original values. This suggests that the narrowing of airway space following mandibular setback using sagittal split osteotomy can be permanent. No significant correlation was found between the amount of mandibular setback and airway space changes. Since the relapse of pogonion point during the following-up period was too small,there is no significant correlation between it and the amount of airway space changes.

Open reduction and internal fixation for displaced supracondylar fractures of the humerus in children with crossed K-wires via lateral approach

Objective： To assess the therapeutic results of open reduction and internal fixation with crossed K-wires via lateral approach for displaced supracondvlar fractures of the humerus in children. Methods： We prospectively followed 52 children who presented with Gartland type 3 displaced supraeondylar fractures of the humerus and were managed by open reduction and internal fixation with crossed K-wires via lateral approach.There were 37 male and 15 female patients; average age was 7.39 years. The most common mechanism of trauma was fall while playing （n=23）, followed by fall from height （n=20）, road traffic accidents （n-5） and fall from standing height （n=2）. In 2 cases, mode of injury was not available. The mean follow-up was 12 months and patients were assessed according to Flynn＇s criteria. Results： Lateral approach provided an excellent view of the lateral column between two nervous planes and enabled an anatomical reduction in all cases. Immobilizing the elbow at 90 degrees or more of flexion was not needed after cross K-wire fixation. Majority of patients regained full range of motion within 6 weeks of pin removal. Two patients had postoperative ulnar nerve injuries that resolved after pin removal. The common late complication of cubitus varus was not seen in any patient. Delayed presentation to the emergency department, repeated manipulations by bone setters and massage with edible oil were responsible for stiffness in 5 patients. Superficial pin tract infection was noted in 5 patients that resolved with dressings and antibiotics. No deep infection occurred. A detailed clinical examination and radiographic analysis was done at final follow-up. They included measurement of carrying angle and range of movements of both operated and normal sides, and radiographs of both upper limbs for comparison. According to Flynn＇s criteria, 90.4% patients showed satisfactory results. Conclusion： Lateral approach for open reduction and internal fixation of the widely-displaced supracondylar fracture of the humerus is safe and straightforward, ensuring anatomical reduction and excellent function. The approach is easy and familiar to most orthopedic surgeons in our setup.

Comparative study on treating complete dislocation of acromioclavicular joint with three different methods

Objective:To comparatively study complete dislo cation of acromioclavicular joint treated with three different methods. Methods:A total of 96 patients (81 males and 15 females, aged 16-59 years, mean=45 years) with complete dislocation of acromioclavicular join t were treated with Dewars operation (Group A, n=32), internal fixation with K irschner tension band wires (Group B, n=44), or internal fixation with Wolter pl ates (Group C, n=20), respectively, in this study. Eighty-five patients suffere d from acute dislocations and eleven from chronic dislocations. Results:The patients were followed up for 50 months on an aver age. According to Karlssons standard, in Group A, 26 patients were assessed as good, 5 as fair and 1 as poor. In Group B, 20 patients were assessed as good, 1 3 as fair and 11 as poor. In Group C, 15 patients were assessed as good, 4 as fa ir and 1 as poor. The good and fair rates were significantly different between G roup A and Group B, and between Group C and Group B, but no statistical differen ce was found between Group A and Group C. The operating time was ( 52.36 ± 7 .24 ) minutes, ( 67.43 ± 8.11 ) minutes and ( 69.73 ± 8.04 ) minutes in Groups A, B and C, respectively. And the hospitalizing fees were ( 2 400 ± 270) yuan, ( 2 100 ±190) yuan and ( 8 450 ±360) yuan in Groups A, B and C, respectively. Conclusions:Dewars operation is a good and safe method with shorter operating time and lower hospitalizing fee for treating complete disloca tion of acromioclavicular joint. The method is simple without the need of a seco nd operation to remove the implants and with few complications.

Twenty-seven-year nonunion of a Hoffa fracture in a 46-year-old patient

A Hoffa fracture is an uncommon clinical entity typically seen in adults after high-energy trauma. Nonunion ofa Hoffa fracture appears to be even more uncommon. To our knowledge, only three cases of nonunion ofa Hoffa fracture have been documented in the literature to date, including two children and one adult. This article presents a case of an adult who had nonunion of a Hoffa fracture for 27 years and was treated by open reduction and internal fixation, and the varus deformity corrected with xenogenous bone graft. An excellent result has been achieved to date. This unusual case reminds us that we cannot neglect the possibility of nonunion of a cancellous hone fracture, especially the Hoffa fractures of the medial femoral condyle if they are treated nonoperatively. It also demonstrates that internal fixation with bone graft is effective, even for the 27-year Hoffa fracture.

Nonunion of coronal shear fracture of femoral condyle

Isolated coronal fractures of femoral condyle are rare in adults and nonunion of Hoffa fracture is reported only a few times in the literature. We analyzed six cases of nonunion of Hoffa fractures over a period of three years. Three patients were treated conservatively and three patients had fixation failures. Delay of presentation was 2 months to one year. Treatment protocol consisted of open reduction, excision of pseudoarthrosis, bone grafting and internal fixation along with knee arthrolysis. Union wasachieved in all patients at mean 16 weeks. The treatment of nonunion of Hoffa fractures requires careful preoperative planning and meticulous surgical technique. The literature regarding the controversies in fracture management and surgical technique are reviewed.

Transoral atlantoaxial reduction plate fixation for irreducible atlantoaxial dislocation

Objective： To design a clinically applicable transoraipharyngeai atlantoaxiai reduction plate （TARP）, introduce the operation procedure, and evaluate its preliminary clinical effects. Methods： A novel TARP system, including butterfly titanium alloy plate, self-locking screws, atlantoaxial reductor and other operational instruments was developed. This system was applied clinically on five patients with irreducible atlantoaxiai dislocation of congenital or traumatic origin. During operation, the reduction was completed by the combined action of the plate and the atlantoaxiai reductor after transoral joint release and cord decompression. Bone graft granules were implanted between the bilateral atlantoaxiai joints and TARP was used to immobilize subsequently the atlas and axis. Results： Clinical application demonstrated that TARP could induce instant reduction and that the method was operationally feasible and its postoperationai effect was satisfactory. Conclusions： The design of TARP is novel. The operational procedure is simple and easy to use. Furthermore, instant reduction can be completed during the operation and the fixation is relatively stable. TARP is an ideal alternative for irreducible atlantoaxiai dislocation and may have excellent prospects for further clinical applications.

Treatment of Gustilo grade Ⅲ leg fractures by external fixation associated with limited internal fixation

Objective： To explore the clinical effects of external fixation associated with limited internal fixation on treatment of Gustilo grade Ⅲ leg fractures. Methods： From July 2006 to December 2008, 40 cases of Gustilo grade Ⅲ leg fractures were emergently treated in our unit with external fixation frames. Soft tissue injuries were grouped according to the Gustilo classification as ⅢA in 17 cases, ⅢB in 13 cases, and ⅢC in 10 cases. All the patients were debrided within 8 hours, and then fracture reposition was preformed to reestablish the leg alignment. Limited internal fixation with plates and screws were performed on all the Gustilo IliA cases and 10 Gustilo ⅢB cases at the first operation. But all the Gustilo ⅢC cases and 3 Gustilo ⅢB cases who had severe soft tissue injuries and bone loss only received Vacuum-sealing drainage （VSD）. Broad-spectrum antibiotics were regularly used and VSD must be especially maintained easy and smooth for one week or more after operation. Limited internal fixation and transplanted free skin flaps or adjacent musculocutaneous flaps were not used to close wounds until the conditions of the wounds had been improved. Results： The first operations were completed within 90-210 minutes （170 minutes on average）. The blood trans- fusions were from 400 ml to 1500 ml （those used for antishock preoperatively not included）. All the 40 patients in this study were followed up for 6-28 months, 20.5 months on average. The lower limb function was evaluated according to the comprehensive evaluation standards of leg function one year after operation and the results of 28 cases were excellent, 9 were good and 3 were poor. Conclusion： External fixation associated with limited internal fixation to treat Gustilo grade Ⅲ leg fractures can get satisfactory early clinical therapeutic effects.

One stage anterior-posterior approach for traumatic atlantoaxial instability combined with subaxial cervical spinal cord injury

Objectives： To explore the clinical fea- tures of traumatic atlantoaxial instability combined with subaxial cervical spinal cord injury （CSCI）, and to analyze the feasibility, indication and therapeutic effects of anterior-posterior approach in such cases. Methods： From March 2004 to September 2009, 16 cases with this trauma were admitted and surgically treated in our department. Before surgery, skull traction was performed. Posterior atlantoaxial pedicle screw internal fixation and bone graft fusion were conducted to manage traumatic atlantoaxial instability. As for subaxial CSCI, anterior cervical corpectomy or discectomy decompression, bone grafting and internal fixation with steel plates were applied. Results： All operations were successful. The average operation time was 3 hours and operative blood loss 400 ml. Satisfactory reduction of both the upper and lower cervical spine and complete decompression were achieved. All patients were followed up for 12 to 36 months. Their clinical symptoms were improved by various levels. The Japanese Orthopaedic Association （JOA） scores ranged from 10（improvement rate=70.10%）. X-rays, spiral CT and MRI confirmed normal cervical alignments, complete decompression and fine implants＇ position. There was no breakage or loosening of screws, nor exodus of titanium mesh or implanted bone blocks. The grafted bone achieved fusion 3-6 months postoperatively and no atlantoaxial instability was observed. Conclusions： Traumatic atlantoaxial instability may combine with subaxial CSCI, misdiagnosis of which should be especially alerted and avoided. For severe cases, one stage anterior-posterior approach to decompress the upper and lower cervical spine, together with reposition, bone grafting and fusion, as well as internal fixation can immediately restore the normal alignments and stability of the cervical spine and effectively improve the spinal nervous function, thus being an ideal approach.

Minimally invasive plate internal fixation for calcaneal fractures

Objective： To assess the clinical efficacy of minimally invasive plate internal fixation for the treatment of calcaneal fractures. Methods： Manual reduction, rectification of deformity, and cold compress with traditional Chinese medicine were used preoperatively to relieve swelling and pain. A small incision was made to expose the articular facet and to perform anatomic reduction and plate fixation. Self-made traditional Chinese pharmaceutics were applied postoperatively on the surface of the wound to accelerate bony union. Results： All the 40 patients were followed up for at least 1 year postoperatively. According to the Maryland scoring system, the excellent and good rate was 87.5%. Conclusion： Minimally invasive plate internal fixation has the advantages of relatively mild injury, reliable fixation, good recovery, and rare complications in the treatment of intraarticular fractures.

Comparative study on treatment of midshaft tibial fracture with expandable and interlocking intramedullary nails

Objective ： To evaluate the clinical results of treatment of midshaft tibial fracture with expandable intramedullary nails compared with interlocking intramednilary nails. Methods： From June 2003 to August 2005, 46 patients （27 males and 19 females, aged 20-74 years, mean =38.4 years ） with midshaft tibial fracture were treated surgically in our department. The causes of fractures were traffic injury in 21 patients, fall injury in 6, tumbling injury in 11 and crushing injury in 8. According to AO/ ASIF classification, Type A fracture was found in 16 patients, Type B in 11, Type C1 in 5, and Type C2 in 2. Open fractures were found in 12 patients, according to Gustilo classification, Type Ⅰ in 9 patients and Type Ⅱin 3 patients. Based on the patients＇consent, 24 patients were treated with expandable intramedullary nails （Group A ） and 22 with interlocking intramedullary nails （Group B ）. The operation time, blood loss during operation, X-ray fluoroscopic times, hospitalization time, weight bearing time after operation, healing time of fracture and complications of all the patients were recorded. The clinical effects of all the cases were evaluated according to the criteria of Johner-Wruhs. Results： All the patients were followed up for 12,34 months （ mean = 16.2 months）. The time of operation, the blood loss, X-ray fluoroscopic times, hospitalization time and healing time of fracture of Group A significantly decreased （P 〈 0.05 ） compared with those of Group B, but the time for weight bearing after operation, the Johner- Wruhs degree of clinical effects and complications had no significant difference between Group A and Group B （P〉0.05）. Conclusions： Expandable intramedullary nail can shorten operation time, decrease blood loss and reduce invasion, which is a safe and effective treatment method for tibial midshaft fracture.

Efficacy of open reduction and internal fixation with a miniplate and hollow screw in the treatment of Lisfranc injury

Purpose： To investigate efficacy of open reduction and internal fixation with the miniplate and hollow screw in the treatment of Lisfranc injury. Methods： Ten cases of Lisfranc injury treated by open reduction, miniplate and hollow screw in our hospital were retrospectively analyzed. There were 6 males and 4 females with age ranging from 25 to 45 years （mean 32 years）. Among them, one case was classified as Type A, six Type B and three Type C. Injury mechanism included road traffic accidents （3 cases）, fall from height （5 cases） and hit by heavy object （2 cases）. All injuries were closed without cerebral trauma or other complicated injuries. The time interval between injury and operation was 6-10 days （average 6.6 days）. Postoperatively, the foot function was assessed using Visual Analogue Scales （VAS） and American Orthopaedic Foot and Ankle Society （AOFAS） Scales. Healing time and complications were observed. Results： All patients were followed up for 18-24 months （average 20 months）. Anatomic reduction was achieved in all patients on images. There was statistical significance between preoperative score （Z89 ± 0.34） and score at postoperative 8 weeks （0.67 ± 0.13）. According to the AOFAS score, 5 cases were defined as excellent, 3 cases as good and 2 cases as fair. During follow-up, there was no wound infection or complications except for osteoarthritis in 2 cases. Healing time ranged from 3 to 6 months with an average of 3.6 months. Conclusion： Anatomical reduction of Lisfranc injury can be achieved by open reduction and internal fixation with the miniplate and hollow screw. Normal structure of Lisfranc joint is regained to a great extent; injured ligaments were also repaired. Therefore, this method offers excellent curative effect and can avoid postoperative complications and improve the patients＇ quality of life.

Subciliary incision and lateral cantholysis in rigid internal fixation of zygomatic complex fractures

Objective: To introduce the technique of subciliary incision and lateral cantholysis with tri-dimension reduction and rigid internal fixation to treat zygomatic complex fractures. Methods: The subciliary incision and lateral cantholysis combined with tri-dimension reduction and rigid internal fixation of zygomatic complex fractures with titanium microplates were applied in 56 patients with zygomatic complex fractures. Another lateral eyebrow incision or sublabial incision was used to simplify the operation. Results: The postoperative follow-up period ranged from 6 months to 5 years. During the follow-up period, all the patients had satisfying postoperative results. All clinical symptoms disappeared except the numbness in the infraorbital region in 2 patients. In 94.6% patients no complications such as obvious scar, ectropion, entropion or blepharoedema were found, only 5.4% of the patients had slight ectropion 6 months after operation. Conclusions: The subciliary incision and lateral cantholysis have many advantages such as invisible scar, sufficient exposure, minimal injury, and few complications and combined with rigid internal fixation with titanium microplates this technique could be used as one of the routine operation methods to treat zygomatic complex fractures.

Surgical treatment of proximal humerus fractures using PHILOS plate

Objective：To evaluate functional outcome and complications of open reduction and internal fixation with proximal humeral internal locking system （PHILOS） plate for proximal humerus fractures.Methods：We reviewed 51 patients who underwent open reduction and internal fixation with PHILOS plate between the years 2007 to 2012.There were 35 men and 16 women with a mean age of 38 years （range 24-68）.There were 41 patients in the age group of ＜60 years and 10 patients in the age group of ＞60 years.According to Neer classification system,8,15 and 23 patients had 2-part,3-part,and 4-part fractures,respectively and 5 patients had 4-part fracture dislocation.All surgeries were carried out at our tertiary care trauma centre.Functional evaluation of the shoulder at final follow-up was done using Constant-Murley score.Results：The mean follow-up period was 30 months （range 12-44 months）.Two patients were lost to followup.Of the remaining 49 patients,all fractures were united clinically and radiologically.The mean time for radiological union was 12 weeks （range 8-20 weeks）.At the final follow-up the mean Constant-Murley score was 79 （range 50-100）.The results were excellent in 25 patients,good in 13 patients,fair in 6 patients and poor in 5 patients.During the follow-up,four cases of varus malunion,one case of subacromial impingement,one case of deep infection,one case of intraarticular screw penetration and one case of failure of fixation were noted.No cases of avascular necrosis,hardware failure,locking screw loosening or nonunion were noted.Conclusion：PHILOS provides stable fixation in proximal humerus fractures.To prevent potential complications like avascular necrosis,meticulous surgical dissection to preserve vascularity of humeral head is necessary.

Complete L5 burst fracture treated by 270-degree decompression and reconstruction using titanium mesh cage via a single posterior vertebrectomy

Complete burst fractures of the L5 is relatively uncommon.How to accomplish a rigid internal fixation as well as preserve motor function is an enormous challenge.We report such a case treated via a single posterior vertebrectomy with 270-degree decompression and reconstruction using titanium mesh cage.The disc between L5/S1 was preserved by placing the titanium mesh cage on the inferior endplate of the L5.We hope this method can offer a possible solution for other surgeons when they meet a similar fracture pattern.

Reamed or unreamed intramedullary nailing for tibial fractures： a meta-analysis

Objective：To compare the treating effects of different intramedullary nailing methods on tibial fractures in adults.Methods：Literature reports in both Chinese and English languages were retrieved （from the earliest available records to October 1,2013） from the PubMed,FMJS,CNKI,Wanfang Data using randomized controlled trials （RCTs） to compare reamed and unreamed intramedullary nailing for treatment of tibial fractures.Methodological quality of the trials was critically assessed,and relevant data were extracted.Statistical software Revman 5.0 was used for data-analysis.Results：A total of 12 randomized controlled trials,comprising 985 patients （475 in the unreamed group and 510 in the reamed group）,were eligible for inclusion in this meta-analysis.The results of metaanalysis showed that there were no statistically significant differences between the two methods in the reported outcomes of infection （RR=0.64; 95％CI,0.39 to 1.07;P=0.09）,compartment syndrome （RR=1.44; 95％CI,0.8to 2.41; P=0.16）,thrombosis （RR=1.29; 95％CI,0.43to 3.87; P=0.64）,time to union （WMD=5.01; 95％CI,-1.78 to 11.80; P=0.15）,delayed union （nonunion）（RR=1.56; 95％CI,0.97 to 2.49; P=0.06）,malunion （RR=1.75; 95％CI,1.00 to 3.08; P=0.05） and knee pain （RR=0.94; 95％CI,0.73 to 1.22; P=0.66）.But there was a significantly higher fixation failure rate in the unreamed group than in the reamed group （RR=4.29; 95％CI,2.58to 7.14; P＜0.00001）.Conclusion：There is no significant difference in the reamed and unreamed intramedullary nailing for the treatment of tibial fractures,but our result recommends reamed nails for the treatment of closed tibial fractures for their lower fixation failure rate.