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find Keyword "股骨转子间" 81 results
  • THE CLINICAL EFFECT OF BIPOLAR LONGSTEM PROSTHETIC REPLACEMENT ON THE TREATMENT OF COMMINUTED INTERTROCHANTERIC FRACTURE OF HIP IN THE ELDERLY OSTEOPOROTIC PATIENTS

    Objective To evaluate the clinical effect of bipolar long-stem prosthetic replacement on the treatment of comminuted intertrochanteric fracture of hip in the elderly osteoporotic patients. Methods From March 2000 to August 2003, 18 patients who were more than 72 years old with comminuted intertrochanteric fracture were treated with bipolar longstem prosthetic replacement. There were 8 males and 10 females (aged from 72 to 91). Fractured fragments of large trochanter and minor trochanter should be preserved during the operation so that the fragments can be fixed with steel wires and insertion of artificial femoral head.The surgical approach and operative technique, the average course of treatment in hospital, the average time to ambulate with full-weight bearing on the operated limb after the operation, complication, and mortality were observed. Results All patients were followed up 6 to 28 months(16.2 months on average). The average course of stay at hospital was 16 days. The average time to ambulate was 32 days. The incidence of the pain of the hip joint was one-eighteenth, and one patient due to another disease was unable to walk without using twocrutches one month after the surgery. The mortality of the patients was oneeighteenth one year after the surgery. Conclusion Bipolar longstem prosthetic replacement for the treament of comminuted intertrochanteric fractures in the elderly osteoporotic patients proves to be a suitable alternative.Patients have better prognosis, early full-weight bearing, rapid rehabilitation, and fewer complications.

    Release date:2016-09-01 09:29 Export PDF Favorites Scan
  • 股骨近端锁定钢板治疗老年股骨转子间骨折

    目的 总结股骨近端锁定钢板在治疗老年股骨转子间骨折的手术经验及成功率。 方法 对2008年1月-2009年3月收治的57例老年股骨转子间骨折患者,行切开复位股骨近端锁定钢板内固定治疗。 结果 在Evans分型1~5型中手术成功率为100%,优良率为98.2%。 结论 股骨近端锁定钢板适用于老年股骨转子间骨折的各种类型。

    Release date:2016-09-08 09:47 Export PDF Favorites Scan
  • CLINICAL OBSERVATION OF Othofix PERTROCHANTERIC FIXATOR FOR FIXATION OF INTERTROCHANTERIC FRACTURE

    ObjectiveTo evaluate the effectiveness of Othofix pertrochanteric fixator for fixation of intertrochanteric fracture. MethodA retrospective analysis was made on the clinical data from 36 cases of intertrochanteric fracture treated with Othofix pertrochanteric fixator (OPF group) and 47 cases treated with Gamma nail (Gamma group) between October 2012 and March 2015. There was no significant difference in gender, age, cause of injury, side, AO fracture classification, combined medical disease, and injury to operation time between 2 groups (P>0.05) . The operation time, intraoperative blood loss, hospitalization time, fracture union time, and complication rate were recorded and compared between 2 groups. Hip function was evaluated with Sanders post-trauma criteria. ResultsThe operation time, intraoperative blood loss, and hospitalization time of the OPF group were significantly less than those of the Gamma group (P<0.05) . All the cases were followed up 6-12 months (mean, 8.8 months) in 2 groups. Healing of incision by first intention was obtained. Bone union was achieved in 2 groups, and the fracture union time of the OPF group was significantly shorter than that of the Gamma group (t=14.780, P=0.000) . There was no deep wound or pin track infection in 2 groups. Superficial skin reactions developed around the screw and the pins in 14 cases (38.9%) of the OPF group, but no incision infection in the Gamma group, showing significant difference (χ2=22.010, P=0.001) . Mild varus of the hip and pin cutting-out occurred in 3 cases (8.3%) and 2 cases (5.6%) of the OPF group, and in 4 cases (8.5%) and 3 cases (6.4%) of Gamma group, showing no significant difference (χ2=0.001, P=0.960; χ2=0.025, P=0.830) . According to Sanders post-trauma criteria, the results were excellent in 16 cases, good in 15 cases, fair in 3 cases, and poor in 2 cases, with an excellent and good rate of 86.1% in the OPF group; the results were excellent in 22 cases, good in 20 cases, fair in 4 cases, and poor in 1 case, with an excellent and good rate of 89.4% in the Gamma group; and there was no significant difference (χ2=0.200, P=0.610) . ConclusionsThe Othofix pertrochanteric fixator has good effectiveness in the treatment of intertrochanteric fracture, which has the advantages of simple operation, less operation time, little bleeding, and early functional recovery.

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  • 外固定支架在老年股骨转子间骨折的应用

    【摘 要】 目的 评价外固定支架对老年股骨转子间骨折的治疗作用。 方法 2003 年1 月- 2005 年12 月,用外固定支架治疗高龄股骨转子间骨折60 例。其中男37 例,女23 例;年龄73 ~ 95 岁,平均83 岁。骨折至治疗时间2 ~ 15 d,平均5 d,平均12 周;按AO 分型,A1 型22 例,A2 型30 例,A3 型8 例。均合并多种内科疾病而不能耐受内固定手术。 结果 外固定架操作手术时间20 ~ 40 min,平均30 min,术中无明显出血,术中及术后未输血。所有患者均获随访8 ~ 24 个月,平均18 个月。无外固定失败者。全部骨折愈合,愈合时间10 ~ 16 周,平均12 周。无死亡者。有髋内翻畸形4 例;钉道感染8 例,经口服抗生素及局部换药等处理好转,拔除外固定钉后钉道感染痊愈。髋关节功能情况按Harris 评分系统进行评分:优35 例,良22 例,差3 例,优良率95%。 结论 外固定支架治疗股骨转子间骨折具有手术安全、创伤小、失血量少等优点,是治疗老年转子间骨折的良好选择。

    Release date:2016-09-01 09:09 Export PDF Favorites Scan
  • Standard radiographic images in cephalomedullary nailing fixation for intertrochanteric femoral fractures

    Objective To review and summarize the projections of radiographic images during cephalomedullary nailing fixation for intertrochanteric femoral fractures, and to propose a set of three projections as standard requirement in immediate postoperative fluoroscopy. MethodsPapers on intertrochanteric femoral fractures treated with cephalomedullary nailing fixation that published in a three-year period of 2021—2023 in four leading English orthopedic trauma journals were searched in PubMed. The presented radiographic pictures were identified and scrutinized as whether they were in standard anteroposterior and/or lateral projections of the implanted nails. The nonstandard presence percentage was calculated. Combined with clinical experience, the standard anteroposterior and lateral perspective images of femoral neck, the current situation of radiographic imaging in the operation of cephalomedullary nails, the literature analysis of nonstandard images, the impact of limb rotation on image interpretation, and the characteristics of anteromedial 30° oblique perspective were summarized and analyzed. Results The presence of nonstandard radiographic pictures is 32.1% in anteroposterior view and 69.2% in lateral view in leading orthopedic trauma journals. In cephalomedullary nailing fixation operation of intertrochanteric femoral fractures, it is reasonable to use the radiographic images of the implanted nails to represent the fractured head-neck, as the head-neck implant (lag screw or helical blade) is aimed to put into centrally in femoral head in lateral projection. Limb rotation or nonstandard projections produced distortion of images, which interfers the surgeons’ judgement of fracture reduction quality and the measurement of implant position parameters in femoral head (such as neck-shaft angle and tip-apex distance), and finally lead to a meaningless comparison with the accurate normal value. The 30° anteromedial oblique view from the true lateral (set as 0°) is a tangential projection of the cortices at the anteromedial inferior corner, which gives a clear profile for the determination of cortical apposition status and mechanical support. It is essential to get firstly the true standard lateral fluoroscopy of the nail (shown as a line), then rotate the C-arm to 90° and 30° to get anteroposterior and anteromedial oblique views, and use these three immediate postoperative radiographies as the baseline for evaluation of operative quality and follow-up comparisons. Conclusion As for real-time monitoring of surgical steps, intraoperative fluoroscopy follows the “Enough is Good” principle, but as for immediate postoperative data storage and basis for operative quality evaluation and baseline for follow-up comparison, it is recommended to obtain a set of three standard radiographic pictures in anteroposterior, true lateral, and 30° anteromedial oblique fluoroscopic projections.

    Release date:2024-10-17 05:17 Export PDF Favorites Scan
  • Proposal of a novel comprehensive classification for femoral intertrochanteric fractures

    Objective To introduce a novel comprehensive classification for femoral intertrochanteric fractures, and to accommodate the clinical requirement for the world-wide outbreak of geriatric hip fractures and surgical operations. Methods On the basis of reviewing the history of classification of femoral intertrochanteric fractures and analyzing the advantages and disadvantages of AO/Orthopaedic Trauma Association (AO/OTA) classification in different periods, combined with the current situation of extensive preoperative CT scan and three-dimensional reconstruction and widespread use of intramedullary nail fixation in China, the “Elderly Hip Fracture” Research Group of the Reparative and Reconstructive Surgery Committee of the Chinese Rehabilitation Medical Association proposed a novel comprehensive classification for femoral intertrochanteric fractures, focusing on the structure of fracture stability reconstruction during internal fixation. Results The novel comprehensive classification of femoral intertrochanteric fractures incorporates multiple indicators of fracture classification, including the orientation of the fracture line, the degree of fracture fragmentation, the lesser trochanteric bone fragment and its distal extension length (>2 cm), the posterior coronal bone fragment and its anterior extension width (involving the lateral cortex of the head and neck implant entry point), transverse fracture of the lateral and anterior wall and its relationship with the implant entry point in the head and neck, and whether the cortex of the anteromedial inferior corner can be directly reduced to contact, etc. The femoral intertrochanteric fractures are divided into 4 types (type A1 is simple two-part fractures, type A2 is characterized by lesser trochanter fragment and posterior coronal fractures, type A3 is reverse obliquity and transverse fractures, type A4 is medial comminution which lacks anteromedial cortex transmission of compression force), each of which is subdivided into 4 subtypes and further subdivide into finer subgroups. In a review of 550 trochanteric hip fracture cases by three-dimensional CT, type A1 accounted for 20.0%, type A2 for 62.5%, type A3 for 15.5%, and type A4 for 2.0%, respectively. For subtypes, A2.2 is with a “banana-like” posterior coronal fragment, A2.4 is with distal cortex extension >2 cm of the lesser trochanter and anterior cortical expansion of the posterior coronal fragment to the entry portal of head-neck implants, A3.4 is a primary pantrochanteric fracture, and A4.4 is a concomitant ipsilateral segmental fracture of the neck and trochanter region. ConclusionThe novel comprehensive classification of femoral intertrochanteric fractures can describe the morphological characteristics of fractures in more detail, include more rare and complex types, provide more personalized subtype selection, and adapt to the clinical needs of both fractures and surgeries.

    Release date:2022-09-30 09:59 Export PDF Favorites Scan
  • A comparative study on effectiveness of closed reduction and internal fixation of intertrochanteric fracture assisted with skeletal tractor and traction table

    ObjectiveTo investigate the effectiveness and advantages of skeletal tractor in closed reduction and proximal femoral nail antirotation (PFNA) internal fixation of intertrochanteric fracture compared with traction table.MethodsThe clinical data of 86 patients with intertrochanteric fractures, who were treated with closed reduction and PFNA internal fixation between October 2016 and March 2018 and met the selection criteria, was retrospectively analysed. Among them, 44 cases were treated with skeletal tractor (trial group) and 42 cases were treated with traction table (control group). There was no significant difference between the two groups in gender, age, cause of injury, fracture side, AO classification, and degree of osteoporosis (P>0.05). The preoperative position time, operation time, intraoperative fluoroscopy times, intraoperative blood loss, fracture healing time, intraoperative and postoperative complications, and postoperative Harris score were compared between the two groups.ResultsThe operation was successfully completed in both groups. Compared with the control group, the patients in the trial group had shorter preoperative position time and operation time, fewer intraoperative fluoroscopy times, and less intraoperative blood loss (P<0.05). The patients were followed up 12-21 months in trial group (mean, 14.2 months) and 12-22 months in control group (mean, 14.3 months). Venous thrombosis of lower extremity occurred in 8 patients (3 cases of trial group and 5 cases of control group) after operation. Internal fixation failure occurred in 5 patients (2 cases of trial group and 3 cases of control group) during 1 year after operation. All fractures healed except for those with internal fixation failure, the fracture healing time was (11.6±2.9) weeks in trial group and (12.4±3.6) weeks in control group; and there was no significant difference between the two groups (t=1.250, P=0.214). At 1 year after operation, Harris score of the trial group was 86.2±5.9 and that of the control group was 84.1±6.1. There was no significant difference between the two groups (t=1.768, P=0.080).ConclusionCompared with traction table, skeletal tractor in closed reduction and PFNA internal fixation of intertrochanteric fracture can significantly shorten the preoperative position time and operation time, reduce the intraoperative fluoroscopy times, improve the operation efficiency, and have similar effectiveness.

    Release date:2020-04-29 03:03 Export PDF Favorites Scan
  • Effect of enhanced recovery after surgery on perioperative management of elderly patients with intertrochanteric fractures

    ObjectiveTo explore the clinical effect of applying the concept of enhanced recovery after surgery (ERAS) to the perioperative management of elderly patients with intertrochanteric fractures.MethodsThe clinical data of 64 elderly patients with intertrochanteric fractures admitted to West China Hospital of Sichuan University from January 2016 to December 2017 were retrospectively analyzed. Among them, 32 patients admitted from January to December in 2017 were in ERAS group, and 32 patients admitted from January to December 2016 were in control group. The control group used conventional orthopedic perioperative management measures, and the ERAS group combined the ERAS concept on the basis of conventional treatment measures for perioperative management. The incidence of perioperative complications, Visual Analogue Scale score, modified Barthel Index score, inpatient satisfaction and length of hospital stay were compared between the two groups.ResultsThere was no significant difference in age, gender, American Society of Anesthesiologists grade, combined disease, modified Barthel Index or Visual Analogue Scale score at admission, or time from injury to surgery between the two groups (P>0.05). The total incidence of perioperative complications (12.5% vs. 37.5%) and length of hospital stay [(8.09±2.33) vs. (10.41±3.63) d] in the ERAS group were lower than those in the control group (P<0.05). The Visual Analogue Scale scores of the two groups of patients before operation, on the first day and the third day after operation were lower than those at admission (P<0.05). The comparison between the two groups at each time point showed that the Visual Analogue Scale scores of patients in the ERAS group were lower than those in the control group before operation, on the first day and the third day after operation, and the differences were statistically significant (P<0.05). The modified Barthel Index scores of the two groups of patients on the third day, and 1 month, 3 months and 6 months after operation showed a rising trend with time. The modified Barthel Index scores of the ERAS group were better than those of the control group on the third day, and 1 month and 3 months after operation (P<0.05). There was no significant difference between the two groups 6 months after operation (P>0.05). The hospitalization satisfaction score of the ERAS group was 95.56±5.12, which was higher than that of the control group (92.84±5.62), and the difference was statistically significant (P<0.05).ConclusionsThe implementation of ERAS perioperative management for elderly patients with intertrochanteric fractures may reduce the incidence of perioperative complications, relieve patient pain, promote the short-term recovery of activities of daily living of patients, improve the inpatient satisfaction and shorten the length of hospital stay.

    Release date:2021-10-26 03:34 Export PDF Favorites Scan
  • 人工股骨头置换治疗高龄股骨转子间骨折

    目的 总结人工股骨头置换治疗高龄复杂股骨转子间骨折的早期疗效。 方法 2003 年5 月-2007 年6 月,采用双动人工股骨头置换治疗高龄股骨转子间骨折36 例。男12 例,女24 例;年龄73 ~ 92 岁,平均83岁。均为跌倒后髋部着地所致骨折。骨折至手术时间3 ~ 20 d,平均8 d。按AO 分型,A1 型3 例,A2 型25 例,A3 型8 例。 结 果 36 例患者均安全渡过围手术期。获随访6 ~ 30 个月,平均18 个月。术后X线片示假体无松动、下沉及脱位,股骨近端无骨溶解或骨吸收,未发现异位骨化。随访末期Harris 评分75 ~ 93 分,平均91 分;术后评价优20 例,良12 例,可4 例,优良率88.9%。 结论 人工股骨头置换治疗高龄复杂股骨转子间骨折近期随访效果满意,但这一术式技术要求高,应严格掌握适应证。

    Release date:2016-09-01 09:19 Export PDF Favorites Scan
  • 动力髋螺钉加防旋拉力钉治疗股骨转子间骨折

    目的 总结动力髋螺钉(dynamic hip screw,DHS)加防旋拉力钉治疗股骨转子间骨折的疗效。 方法 2006 年1 月- 2009 年1 月,收治35 例股骨转子间骨折。男25 例,女10 例;年龄16 ~ 78 岁,平均45.2 岁。致伤原因:交通事故伤16 例,摔伤19 例。均为单侧骨折,其中左侧22 例,右侧13 例。骨折按照Evans 分型标准:Ⅰ型10 例,Ⅱ型15 例,Ⅲ型8 例,Ⅳ型2 例。受伤至入院时间为1 h ~ 6 d,平均2.3 d。入院后行患肢皮牵引,对症处理合并伤,于2 ~ 7 d后行DHS 加防旋拉力钉内固定术。 结果 术后切口均Ⅰ期愈合,无下肢深静脉血栓形成等早期并发症发生。32 例获随访,随访时间12 ~ 24 个月,平均18.6 个月。X 线片检查示32 例骨折均获骨性愈合,愈合时间为6 ~ 12 个月,平均10个月。术后12 个月根据Parker 等的评定标准评价疗效:获优24 例,良5 例,中3 例。随访期间无髋内翻、内固定物松动、双下肢不等长及患肢短缩外旋畸形等并发症发生。 结论 DHS 加防旋拉力钉可有效防止股骨头旋转,患者可早期功能锻炼,是治疗转子间骨折的有效方法之一。

    Release date:2016-08-31 05:42 Export PDF Favorites Scan
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