| Objective：To discuss a reasonable treatment for unstable intertrochanteric fractures insenile patients by comparing the effects of cemented bipolar hemiarthroplasty（BHR） and locking compression plate（LCP）.Methods：The clinical and radiological records of36senile patients with unstableintertrochanteric hip fractures treated by BHR（20cases） and LCP（16cases）from January2009to December2010were retrospectivelyreviewed.Comparison and statistical analysis were made between the twogroups in terms of the average hospitalization days，length of incision，operative time，blood transfusion，incidence of complications，and the Harriship score at1month，3months，6months，12months after surgery.Groups: cemented bipolar hemiarthroplasty（BHR）:the total number is20cases including5males and15females, aged70～95years, and the averageyear is80years. Mechanism of the injury:18cases for falling,2cases fortraffic accidents.12cases with medical diseases,7cases with one kind ofmedical disease,1case with two kinds of medical disease,4cases with there kinds of medical diseases. Evens classification: Ⅲ type13cases,Ⅳ type7cases. Locking compression plat（eLCP）: the total number is16cases including3males and13females, aged70～86years, and the average year is77years.Mechanism of the injury:13cases for falling,3cases for traffic accidents.10cases with medical diseases,5cases with one kind of medical disease,5casewith two kinds of medical disease. Evens classification: Ⅲ type11cases,Ⅳtype5cases.Get the history of the patients after admission, understand the mechanismof injury, conduct a detailed examination, get the preoperative hip functionHarris score, and do routine examination and imaging(X-ray, CT, etc.). Allpatients were given anteroposterior and lateral hip X-rays in order to find outthe type of the fracture of Evans. Take different Surgical approachs accordingto the preoperative imaging data and the body condition.Pay attention to patients with heart, lung diseases and diabetes andrequest relevant concultations. Give other relevant treatments before theoperation until patients can tolerate the surgery. Do routine examinationincluding blood, urine, heart function and so on. Correct the anemia, the ionand acid-base balance.Operations: cemented bipolar hemiarthroplasty （BHR）:Adopt theposterolateral incision of the hip, retain the attachment of the gluteal muscle atthe top of the greater trochanter in the surgery, protect the fragments of the thegreater trochanter and the lesser trochanter, avoid iatrogenic fracture with appropriate expansion of the bone, note that reservation and reconstruction ofthe femoral calcar, place a suction drainage box after the operation. Lockingcompression plate（LCP）: Patients were placed in traction bed, reduct it withtraction, abduction, and internal rotation under the C-arm X-ray, adopt aproximal lateral incision of the thigh after the satisfactory reduction, avoiddestroying the periosteum as little as possible, select the appropriate nail plate,place three Kirschner wires, screw into three suitable length of the hollowlocking screws after satisfaction with the loction and length of the Kirschnerwires under the C-arm X-ray, screw into four appropriate length locking screwsin turn in proximal femur, get a satisfactory reduction under the C-arm X-ray.Results：Two group were followed up with12months.The BHR group have muchshorter operative time than the LCP group（P＜0.05）and the differencesbetween the two groups were not significant in the average hospitalizationdays，length of incision，blood transfusion（P＞0.05）.The incidence ofcomplications between the two groups was not significant in terms of veinthrombosis，cerebral thrombosis，lung disease，decubitus and total diseases. TheHarris hip score of the BHR group at1month after surgery was higher than theLCP group（P＜0.05），and the Harris hip score at3months after surgerybetween two groups was of no statistical significance（P＞0.05），the Harris hipscore of LCP group at6months and12months after surgery was higher thanthe BHR group（P＜0.05）. Conclusion：1、The difference between the BHR group and the LCP group was notsignificant in the average hospitalization days，length of incision，bloodtransfusion and the Harris hip score at3months after surgery；the BHR grouphave advantages of short operative time and better function of the hip at earlytime after surgery，but the LCP group have better long-term function of the hip；2、 Both of the two methods are reasonable treatment for the unableintertrochanteric hip fractures in senile patients.3、There are some limitations in the accuracy and comprehensiveness of theresults because of the limited number of cases. It is necessary to conduct afurther study of the large samples to understand the recovery of joint functionand long-term complications of the BHR group and the LCP group. |
PDF Full Text Request