| Part1 A comparison on long and short Gamma nails in the treatment ofintertrochanteric fracture in aged Patients.Objective: To investigate short-term outcomes of long and short Gamma nails in the treatment of intertrochanteric fracture in aged patients.Methods: We retrospectively reviewed patients with intertrochanter fractures treated in our hospital from Dec. 2011 to Dec, 2012. A total of 325 patients suffering from intertrochanteric fractures were investigated. Among 247 patients over 65 years old, 8 were not suitable for surgery due to medical disorder, 53 were treated with other fixation methods(e.g. DHS and PFN) and 186 received the treatments of Gamma nails. In those 186 patients, in addition to 30 without follow-up, 156 were followed up for12 months, with 59 treated with long nail and 97 with short nail. There were 97 cases in short nail group, with mean age of 80.0 years old(65-94 years) and 29male/68 female, 58 left/ 39 right, and AO type: 31 A1 35 cases, and 31 A2 62 cases. There were 59 patients in long nail group with mean age of 79.5 years old(65-93), including 19 males and 40 females, 38 left side and 21 right side, and AO type of 31A1 13, 31A2 38, and 31A3 8. Patient medical charts were reviewed. Some factors were collected for comparison, including operation time, weight-bearing time, time of intra-operative X-ray, the amount of intra-operative blood loss, time of bone-union and postoperative complications.Results: Our data showed that there appears no difference in the amount of intra-operative blood loss, weight-bearing time and time of bone-union between the two groups. Patients treated with short Gamma nail have shorter operating time(53.1±8.51 minutes for short nail vs 60.6±11.43 minutes for long nail, p =0.000), and time of intra-operative X-ray use(26 for short nail vs 33 for long nail, p=0.000). It is shown that three cases of femur re-fracture, 10 cases of thigh pain, and 3 cases of hip pain occurred in short nails with the ratio of 16.5%, while only 3 cases of thigh pain took place in long nail group with the ratio of 5.1%.Conclusions: Both long and short Gamma nails are optional internal fixation alternatives with good functional outcomes in treating intertrochanteric fracture in aged patients over 65 years old. Patients with long nails could avoid refracture of femur, with reduced thigh pain after operation. It is shown that it is safe for postoperative to have a partial weight-bearing walk at 2 days in long nail and 7 days in short nail. Part 2 Hyponatremia after Intertrochanteric fractures in aged patientsObjective: To investigate hyponatremia in aged patients with intertrochanteric fractures and explore the relationship between hyponatremia and medical disease.Methods: Seventy-six aged patients with intertrochanteric fracture were involved, of which 54 cases had medical disorder. Serum sodium levels were detected at time points of 1d and 3d respectively after admission. We investigated the incidence of hyponatremia in patients with or without medical disease, to observe the relationship of hyponatremia occurrence with age, fracture type and medical complications and explore the influence of hyponatremia by food eating.Results: Thirty-eight out of 76 patients had hyponatremia, including 22 cases with mild hyponatremia and 16 cases with moderate hyponatremia. There was no statistical significance in patients with or without medical disorder( with the ratio of hyponatremia of 40.9% and 53.8%, P>0.05). Compared with patients with or without cardiovascular disease and patients with or without diabetes mellitus, there was no statistically significance(P=0.646 and P=0.262). The incidence of hyponatremia in casese with lung disease was higher than that without it(X2=4.415,P=0.042). There was statistical significance in patients whose food intake were less than 1/2 of constant and more than the level(ratio of hyponatremia was 78.6% and 14,7%X2=13.5, P <0.005).Conclusion : Hyponatremia is common in aged patients with intertrochanteric fracture, most of whom were mild or moderate hyponatremia. Hyponatremia was more likely to take place in patients suffering from lung disease. Poor eating is the main reason of hyponatremia. Part 3 The value of Femoral neck- greater sciatic notch line forneck-shaft AngleObjective: To explore the value of the femoral neck- big sciatic notch line to evaluate the femoral neck-shaft AngleMethods: Femoral neck- big sciatic notch line(N-SN line) is defined as that on the X-ray plain of pelvis, an arc tangent was made from the edge of the femoral neck and femoral less or tuberosity. In normal cases, the will line get through the top point of big sciatic notch. Vertex-Center line( V-C line) was defined as the line between femoral greater tuberosity vertex and the center of femoral head. The femoral neck-shaft Angle was measured, with the analysis on the relationship among it with the femoral neck- big sciatic notch line and Vertex-Center line. A- N and A- N- SN Angle was measured, and its relationship with the neck-shaft Angle was also calculated.Results In the cases of N- SN lines getting through the big sciatic notch, there were 50 femalecases, and 40 male cases. The average neck-shaft Angle in patients with N- SN lines getting through large sciatic notch was 136.34°. The neck-shaft Angle in cases with N- SN lines lower than the large sciatic notch was129.43°. There were significantly diffrences between the two groups(t=9.245,P<0.001)In cases with V-C line getting through the center of the femoral head, the neck-shaft Angle was 134.95°on average(male 37 cases, female 34 cases). For patients with femoral head center under the V-C line, the average neck-shaft Angle was 130.40°,(10 male cases, 8 female cases). With femoral head center above the V-C line, the neck-shaft Angle was 135.41°on average(male 9 cases, female 24 cases), and there were significantly differences among the three groups(F=4.839,P=0.010)。To compare the value of N- SN lines and V-C line for evaluating neck-stem angel, X2 = 6.592, P =0.010, there were significantly statistical differences. To make N- SN line as a standard to evaluate the neck-shaft angle, the area of ROC curve was 0.910, 95% of the internal(0.853, 0.853). It is indicated that the accuracy of N- SN line is useful to evaluate the neck-shaft angle. The influence of gender on N- SN line, X2 = 0.293, P = 0.588, it was prompted that gender has no obvious impact on N- SN lines. The influence of gender on the V-C line, X2 = 4.816, P = 0.090).A- N angle were 42.82°on average, 43.05°in male, and 42.63 in female. In the N- SN line getting through the large sciatic notch cases, the A-N Angle were 41.67°on average, In the N- SN line getting under the sciatic notch cases, the A- N angle were 46.06°on average, and there were significant differences between the two groups(t=-5.088,P<0.001. Femoral head center was online the V-C line, the A- N angle were 42.63°on average, and the femoral head center were under the V-C line, the A-N Angle were 41.39°on average, the center of femoral head were above the V-C line, and the average A- N angle is 47.20°, It can be seen that statistical differences were obvious(F=11.256,P<0.001).The mean of A- N- SN angle was 23.38°, with 23.78°in male and 23.04 in female. In the cased with N- SN line getting through the large sciatic notch, the A-N-SN Angle were 22.56°on average, In the N- SN line getting under the sciatic notch cases, the A – N-SN angle were 25.69°on average. There were significant differences between the two groups(t=-3.802,P<0.001). Femoral head center was online the V-Cline, the A – N-SN angle were 23.31, the center of femoral head were under the V-C linet, the A-N-SN Angle were 22.31°on average, and the center of femoral head were above the V-C line, the average A- N –SN angle is 26.33°, and three were significant differences among the three groups( F=5.609,P=0.005)Conclusion: It shows higher accuracy using N- SN line to evaluate neck-shaft Angle, which was easy to grasp. A- N angle and A- N- SN angel could help to determine neck-shaft Angle. |
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