Dynamic hip screw for the treatment of femoral intertrochanteric fractures in 27 cases of Luo Jianping self-reliance (Zhangjiajie People's Hospital of Hunan Province, Zhangjiajie 427000, Hunan Province) femoral neck fracture/treatment; bone screw; fracture fixation, internal fracture using dynamic hip screw ( DHS) internal fixation, after 6 months to 5 years of follow-up, satisfactory results. It is reported as follows.
1 Clinical data General information The group of 27 patients, 9 males and 18 females; mean age 64 (40 ~ 83) years; 13 cases on the left, 14 cases on the right; according to Evans classification: stable 5 cases, type I 3 For example, 2 cases were type; 22 cases were unstable, 14 cases were type I, and 8 cases were W8.
Surgical methods were performed before the operation of tibial tuberosity traction to fracture reduction, epidural anesthesia, the upper femoral incision showed the greater trochanter and femoral shaft, and the affected limb was placed in the abduction internal rotation to reduce the fracture. Place the angle ruler at 2.5~3cm below the big trochanter, drill the guide pin, and align the C-arm X-ray machine so that the needle tip reaches the femoral head under the cortex 1~1.5cm, and expand the L along the guide needle with the combined reamer. , select the appropriate thread to screw in. The steel plate is mounted, and the sleeve of the steel plate is slid on the screw by a presser. The steel plate is attached to the cortical surface, the steel plate screw is placed, and the thick screw tail screw is finally inserted. If the fracture still moves when rotating, add a lag screw on the inside of the large trochanter to resist rotation. The small rotors are separated and displaced by wire bundling or screws to fix them. After the internal fixation of the C-arm X-ray machine was satisfactory, the negative pressure drainage was performed and the incision was closed.
Postoperative treatment of negative pressure suction for 24 to 48 hours, on the second day after surgery, Luo Jianping (1964 Deputy Chief Physician, mainly engaged in trauma orthopedics, spinal surgery clinical work.
From the beginning, early knee flexion and extension and quadriceps functional exercise. Type I, type fractures, walking for 4 to 6 weeks, I and W should be properly extended, and the weight should be completely healed after healing.
2 The results of the treatment were all healed in one stage. The X-ray films showed satisfactory internal fixation. Three cases of small trochanter were not completely restored, and the other fractures reached anatomical or near anatomical reduction. In this group, 27 patients were followed up for 6 months to 5 years, and all fractures healed. The healing time averaged 3.2 months. Evaluation of hip function recovery according to excellent: no pain, normal function, hip without varus deformity, self-care, a total of 23 cases; good: mild pain, can take a long way, mild lameness, hip varus deformity <10 °, limb Shortened by <1.0cm, a total of 3 cases; poor: still pain, walking and living self-care difficulties, hip varus deformity> 20 °, only 1 case, this case is senile dementia patients.
3 Discussion of preoperative preparation, active medical treatment and postoperative care are the key to reducing the mortality and complications of intertrochanteric fractures. Most patients with intertrochanteric fractures are old and frail, with varying degrees of important organ diseases such as hypertension, diabetes, heart disease, chronic bronchitis, and pulmonary heart disease. Before the operation, a comprehensive physical examination must be performed to correctly evaluate the operation and 18 cases of acetabular fractures. Li Jiefeng Hou Yinglan Cheng Minghua Xiao Xungang Peng Zhongcai Tang Yanping Luo Wei Wang Zhihua (Hunan City, Zhejiang Province, First People's Hospital, Hunan Zhangzhou hip fracture / treatment The traditional treatment of acetabular/injury for acetabular fractures is closed traction, often due to incomplete reduction, femoral head necrosis and traumatic arthritis, and the effect is not good.
From 1998 to 2001, the authors performed an open reduction on 18 displaced acetabular fractures, and AQ reconstruction plate fixation, and received good results.
1 Clinical data 1.1 General information The group of 18 patients, 14 males and 4 females, with an average age of 35 (18-45) years old. There were 5 cases of posterior column and posterior wall fracture, 3 degree of drunk tolerance in transverse fracture, and comprehensive treatment such as anti-inflammatory, blood pressure lowering, blood sugar lowering and myocardial blood supply before operation. With the surgical methods, the improvement of internal fixation materials, the incidence of surgical treatment and conservative treatment complications are not significantly different, generally advocate surgery, especially for young and middle-aged patients with type I and IV fractures should be treated surgically.
Interstitial fractures rarely occur in nonunion, but the incidence of hip varus deformity is very high, so the choice of internal fixation should be emphasized. Commonly used McDonald's goose nails, DHS. Mai's goose head nails can occur loosening of the nail tail screw, weak resistance to varus stress, high incidence of hip varus deformity, only suitable for stable type 1 and 11 fractures. The DHS screw is attached to the plate by a sleeve, which decomposes the load applied to the femoral head into two component forces that cause the proximal fracture segment to varus and press down along the screw axis. The special connection of the DHS nail plate can effectively resist the varactor force and retain the axial component of the compression of the fracture, thus maintaining the stability of the fracture. However, the anti-rotation is poor. For some type I and V fractures, a lag screw is needed to assist the anti-rotation. For those with more medial cortical bone defects, some authors advocate patella transplantation to maintain the stability of the fracture and reduce the varus stress. For the small trochanteric fracture, most authors advocate reduction, because the medial cortical bone of the upper femur loses support, the stability of the fracture site decreases, and hip varus is prone to postoperative. In this group, 3 patients had mild hip varus (<10°) after surgery due to poor placement of the small rotor. The ideal screw position should be at the junction of the trabecular bone and the pressure trabecular bone and at the center of the femoral head, and to the inside of the femoral neck.
The biggest advantage of DHS is that the internal fixation design is reasonable and conforms to the biomechanical principle. The nail plate structure is strong and firm, and the inversion shear force is transformed into the compressive stress at the fracture end, which is beneficial to the healing of the fracture and prevention of hip varus. Exercise, reduce bed time, and restore limb function quickly.
Lu Wei, Luo Xianzheng. Treatment analysis of 203 cases of intertrochanteric fractures. Journal of Bone and Joint Injury, 1991, 6(1): 6-7. Wu Jinghua, Wu Yueqi, Huo Huachun, et al. Experience in internal fixation of intertrochanteric fractures. Chinese Journal of Orthopaedics, 1995, 2 (2): 126. Lin Juntao, Fang Xiaofei. Sliding compression goose nail for the treatment of unstable femoral intertrochanter (Editor: Wang Renshun)
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