| Objective:66 cases of young patients with intertrochanteric fracture treatment, to explore the young of different treatment of intertrochanteric fractures of the choice made for the clinical work of some guidance.Methods:Japanese Friendship Hospital of Jilin University, Department of Orthopaedics from January 2006 to January 2010 during the middle-aged patients with intertrochanteric fractures,66 cases were studied retrospectively analyzed. Proximal femoral nail agree to plate (LCP) fixation and the treatment group receiving the DHS fixation and the control group.At treatment,19 males and 5 females, aged 19-48 years, mean 36.5 years. Location:10 cases of left and right in 16 cases,2 cases of bilateral fractures at the same time. Fracture type:fracture type according to Evans classification:ⅢB-type 12 patients,Ⅳtype 8 patients,Ⅴtype 6 patients. Mechanism of injury: 8 cases of falling from height injuries,16 cases of car accident injuries.3 cases with multiple fractures, hypertension in 2 cases. Proximal femoral nail plate (LCP):Bell, Beijing Institute of Biotechnology, management development, as qualified by the State Quality Supervision, locking plate and locking screw. Control group 42 cases,33 males and 9 females, aged 18-60 years, mean 43.6 years old. Parts:the left side in 19 cases,24 cases of right side, while bilateral fracture in 1 case. Fracture type:fracture type according to Evans classification: III B type in 35 patients, IV type 8 patients. Mechanism of injury:six cases of falling from height injuries,30 cases of traffic accident injuries,8 cases falls. Combined with multiple fractures in 8 cases,3 cases of diabetes, hypertension in 4 cases. DHS:Beijing Institute of Biotechnology, Bell management research, identified through the national quality supervision of qualified DHS.At hospital, understanding the mechanism of injury in patients, and patients with a detailed physical examination, clinical data on patients with preoperative hip function Harris score, do hospital routine examination and imaging (x-chip, ct, etc.). All patients were given shooting ipsilateral hip and lateral X-ray, pelvic anteroposterior X-ray film and chest, and then under the limbs and lateral X-ray films to determine the type of fracture of Evans, according to the contralateral hip bone quality conditions to determine its classification of bone Singh. According to preoperative imaging data and treatment plan the case body. Particular attention to whether the impact of the femoral head blood supply of the damage, and patients with complications related to inspection, and requested the relevant department physician consultation, the patients being unable to tolerate surgery may be given the relevant treatment, temporary line of skin traction or Distraction brake until able to tolerate surgery. According to pre-operative examination of patients positive to correct electrolyte, acid-base balance and anemia and other surgical situation. Routine prophylactic antibiotics before surgery to prevent postoperative infection. Temporary suspension of operation may provide skin traction brake, adjust patient status. Including the adjustment of blood volume, heart and lung function and kidney function, so enough to withstand trauma.Proximal femoral nail treatment group plate (LCP):24 patients were lying on the surgical bed, the ipsilateral hip elevated about 20cm. Incision to obtain greater trochanter greater trochanter 2cm below the top 10cm of straight lateral incision, fascia layer cut open and the vastus lateralis muscle to expose the femur below the greater trochanter and the lateral bone surface. According to pre-operative X-ray case, the first traction means to reset the line of C-arm x-ray machine perspective, the location satisfied with the top of the remote away from the greater trochanter is about 0.5-1cm length of the femur to place the appropriate nail plate (LCP), drill and screw into the screw by gold plate. The top plate with 3 holes head lag screw fixation in the femoral neck. To have two screws from the top of the femur. Cortical bone with a fracture of the distal screw fixation. Intertrochanteric fracture of small pieces of fixed screw can be used best, if not, you can be surrounded by a fixed wire, C-arm X-ray machine check reset and fixed the situation. Rinse thoroughly incision, depending on the circumstances placed drainage tube surgery area, sutured incision.The patient lying in orthopedic traction bed, the ipsilateral hip booster, Watson-Jones taking the lateral femoral incision, fascia layer cut open and the vastus lateralis, exposed to the greater trochanter and its below the lateral femoral bone surface. In mild outreach, internal rotating limb traction, closed reduction, in the C-arm X-ray confirmed satisfactory reduction after the peak in the greater trochanter 2-2.5cm below the level of use of 135°neck shaft angle positioning devices, drill into guide pin and the positioning pin, C-arm X-ray examination before and after the guide wire position and lateral position, the location of guide pin after femoral neck axis deviation below the best time to measure the lateral cortical bone length guide the needle to determine the The length of the joint drill, the bone channel, tapping, screw the lag screw diameter of 1cm, then set into the sleeve plate, drill and screw into the screw by gold plate. For large longitudinal lesser trochanter, could have been used cancellous bone compression screw holes through the nail plate at the top two of their lesser trochanter fracture fragments with a fixed, or first reset fixed with steel wires, and then install the DHS unit. After the operating room C-arm X-ray machine and fixed the situation reset routine examination.After surgery, close observation of the patient's vital signs. Routine use of antibiotics after surgery 7-10 days to prevent infection, and in patients given heparin within 24 drugs to prevent venous thrombosis, patients with medical complications to the original control treatment.Results:The proximal femoral nail plate (LCP) group and the DHS group operative time was statistically significant (p<0.05); complications groups p<0.05 statistically significant, also increases bone proximal locking pressure plate (proximal femoral nail plate (LCP)) group and the DHS group according to preoperative, postoperative Harris hip score to compare the decline in value of the recovery of joint function in both groups, t-test, p<0.05, statistically significance.Conclusion:1. For young patients with intertrochanteric fractures of proximal femur nail plate (LCP) fixation and DHS fixation have their own advantages, but there are more advantages of the proximal femur nail plate (LCP) for intertrochanteric fractures and intertrochanteric reverse fractures.2. Femoral proximal nail plate (LCP) fixation of intertrochanteric fractures of the young to reduce the incidence of complications.3. Femoral proximal nail plate (LCP) fixation surgery can save time and reduce surgical trauma, thus significantly reducing surgical complications;4. Intraoperative femoral reconstruction should be taken away from, the success of this relationship to the surgery and postoperative functional recovery of patients is important.5. In this paper, only a small sample of tentative research, large samples of proximal femoral nail plate (LCP) group and the DHS group randomized controlled study possible. The proximal nail plate (LCP) group and the DHS group and the recent restoration of joint function, long-term complications, need to be evidence of a large sample study.
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