Reconstruction intramedullary nail and dynamic hip

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Reconstruction intramedullary nail and dynamic hip screw in treatment of subtrochanteric fractures of long segmental crush Comparative Study

Chinese papers League finishing. Abstract Comparative Analysis of long segments of proximal femoral fractures with interlocking intramedullary nail reconstruction (reconstruction nail) fixation and dynamic hip screw (DHS) in fixed operation time, blood loss, complications, weight-bearing ambulation time, time to fracture healing and clinical efficacy, which is ideal for a internal fixation. [Method] A retrospective analysis of January 2001 ~ January 2006 the Court of surgical treatment of femoral subtrochanteric fractures in patients with long segment in 27 cases, 27 cases according to the different fixation methods were divided into 2 groups, including the DHS fixation group (A group) in 11 cases, 9 males and 2 females, mean 38.75 ± 6.25 years; reconstruction nail fixation group (B) 16 patients, 14 males and 2 females, mean 36.80 ± 4.54 years; on 2 The operation time, blood loss, complications, weight-bearing ambulation time, fracture healing time and therapeutic effect were analyzed. [Results] followed up for 12 to 28 months, an average of 14.71 months and found that a long segment of proximal femoral fracture fixation within 2 hours of surgery (t = 1.78, P> 0.05), bleeding (t = 1.96 , P> 0.05), complications (Fisher exact test P = 0.3 Cool

and the therapeutic effect (Fisher exact test P = 0.50) no significant difference; to load the next time (t = 3.01, P Key words reconstruction of femoral fracture fixation intramedullary nail with dynamic hip screw Abstract: [Objective] To find out a better internal fixation methods of proximal femoral comminuted fracture by compared analysis operation time, blood loss, complications, the time of bear partial burden, the time of union and the therapeutic effect of the reconstructive interlock intramedullary nail and dynamic hip screw. [Method] Retrospective analyzed surgically treated 27 cases proximal femoral comminuted fractures from January 2001 to January 2006. The y were divided into 2 groups with different internal fixation method: 11 cases of them (Group A) were treated by dynamic hip screw, there were 9 males, 2 females, with an average age of 38.75 ± 6.25; 16 cases (Group B) were treated by reconstructive interlock intramedullary nail, there were 14 males, 2 females, with an average age of 36.80 ± 4.54. The results were evaluated by operation time, blood loss , complications, the time of bear partial burden, the time of union and the therapeutic effect of two groups. [Result] The follow-up time were 12-28 months with an average of 14.71 months. No significant difference were found in associated with operation time (t = 1.78, P> 0.05), blood loss (t = 1.96, P> 0.05), complications (Fisher's exact probabilities in 2 * 2 table P = 0.3 Cool

and the therapeutic effect (Fisher's exact probabilities in 2 * 2 table P = 0.50) between two groups. A significant difference were found in associated with the time of bear partial burden (t = 3.01, P <0.05) and the time of union (t = 2.71, P <0> 0.05, t = 0.480), gender (P> 0.05, X2 = 0.092) no significant differences were comparable. 1.2 treatment 1.2.1 preoperative management of patients admitted to hospital, the first dealing with life-threatening injury, expansion of anti-shock, prevention of fat embolism, the affected side in all cases for the Tibia Results phalanx traction. Improve the inspection, the patient in stable condition after surgery using continuous epidural anesthesia. 1.2.2 surgical methods (1) DHS fixation: supine position, elevate the affected side, with lateral hip straight incision to expose the fracture, large bone for the butterfly limited periosteal stripping around the fracture section traction fractures of lower limb restoration, application, or double-stranded wire bundle 7 # silk provisional fixed fracture block. Under the large nodules with 2 ~ 3 cm at 135 ° angle locator used by the keyhole guide wire release. Determine the neck shaft angle and anteversion angle drill into the guide pin, C-arm X-ray machine perspective to determine the central guide pin in the head and neck position, to select the appropriate length of sounding hip screw, adjust the mix of lead wire cutter drilling tool pocket, change Taps tapping, the screw into the cancellous bone screw slide, set into the goose head plate, plate length of the remote control at least four screw holes in the normal tubular bone on the femoral shaft, the plate with screws After the lag screw screwed into the rear compression screw, the larger pieces can be added with fractures of screws, as appropriate, remove the wire. (2) reconstruction of lateral position fixation by Moore incision, starting from the greater tuberosity at the proximal 5 ~ 6 cm incision beginning to fracture at the distal, blunt tubercle line separating Tai vertex. Cone with the bone hole by the pyriform sinus, the bony vertebrae along a guidewire passed through the channel into the bone marrow cavity, medullary cavity with a small amplifier limited reamed, and then expand the device proximal medullary cavity reamed exclusive, choose the appropriate reconstruction intramedullary nail inserted into the bone marrow cavity, positioning the proximal two nodules under the guide pin inserted Tai, C-arm positioning under fluoroscopic X-ray machine, adjust the nail up and down, and make the guide pin in the head and neck into the central location and adjust the depth, into two 6.5 mm lag screw diameter. Try not to peel fracture fragments, by the role of intramedullary nailing of the bracket will block as much as possible anatomical fracture reduction, absorption lines can be bundled with a fixed, and then guided in sight into two distal locking screw. 1.2.3 postoperative treatment without hemostatic, older drugs are available microcirculation, the next day you can sit up gradually from the activities of both lower extremities to reduce deep vein thrombosis. 48 h after removal of drainage, 3 d after the words at the bedside for joint action, 1 week after limb is not weight-bearing walking cane, after periodic review, the situation gradually according to X-line weight-bearing exercise, after a period of reconstruction nails can be changed Fixed-powered. 1.3 efficacy evaluation According to Xing-yan [1] and other proposed evaluation standard femoral shaft fractures were excellent: solid fracture healing, fractures at the canal opened, limb shortening 90 °; Good: fracture a more compact, by continuity of callus, fracture line is not clear, shortening 2 ~ 4 cm, angular deformity 10 ° ~ 15 °, rotational deformity 4 cm, angular deformity> 15 °, rotational deformity> 5 °, knee flexion range of <30> 0.05 no significant difference; surgical blood loss: t = 1.96, P> 0.05 no significant difference; Comparison of postoperative complications of 2 methods: (Fisher exact test) P = 0.38> 0.05, no significant differences, in which DHS fixation group, 1 case infection, 1 case of screw cut out of the femoral head led to coxa vara, reconstruction nail 1 with a fixed nail withdrawal, and 1 hip varus, and 1 limb shortening of about 2 cm. Load time: t = 3.01, P <0.05 significant difference; fracture healing time: t = 2.71, P <0> 0.05).