| Purpose: With the rapid development of people’s life and the extension of average lifespan, the morbidity of femoral intertrochanteric fracture rises. The fractures are usually caused by high-energy injury in young people for their greater bone density. However, as older people often associate with osteoporosis, low-energy forces can lead to fractures, which is more common in the femoral intertrochanteric fractures, 3-4% of all fractures. The sex ratio is about 1: 3[1]. Nowadays, there is no controversy among scholars about the treatment of the intertrochanteric fractures. Surgical treatment is recommended if there is no contraindication [2].There are two main techniques of operation: one is the extramedullary fixation devices, which mainly consist of DHS(Dynamic Hip Screw) and anatomic locking plate. The other is intramedullary fixation devices, including PFN, PFNA, gamma nail, etc. In intramedullary fixation techniques, first guide needle is screwed into the femoral neck, then the AP and lateral radiographs are taken to confirm that the needle is located in the femoral neck, after that locking nail or spiral blade is screwed. Clinically, we found that the direction of guide needle of femoral neck varies with age, which means that the femoral anteversion angle is different. So the purpose of this research is to study the direction of screwing guide needle into the femoral neck during operation, which also means whether the femoral anteversion angle varies with age.Methods: We retrospected the patients of intertrochanteric fracture with surgical treatment between January 2014 and January 2015 in our hospital, and randomly selected 60 cases.All 60 patients are divided into 2 groups according to age. Patients aged over 65 are group 1; age is equal or less than 65 years old are group 2.And each group has 30 patients.Fracture classification based on Evans: group 1: type 5 cases, type 8 cases, type 12 cases, type 5 cases; group 2: type 3 cases, type 7 cases,type 11 cases, type 9 cases. And fracture classification according to AO,group 1:31-A1.1 4 cases, 31-A1.2 7 cases, 31-A1.3.5 cases;31-A2.1 6 cases, 31-A2.2 4 cases, 31-A2.3 2 cases; 31-A3.1 1 case,31-A3.2. 0 case, 31-A3.3 1 case; Group 2:31-A1.1 3 cases, 31-A1.2 5 cases, 31- A1.3.2 cases; 31-A2.1. 8 cases, 31-A2.2 6 cases, 31-A2.3 5 cases; 31-A3.1 1 case, 31- A3.2 0 case,31-A3.3 0 case. Among all these patients,18 patients in group 1 were associated with one or more medical diseases such as: diabetes,coronary heart disease,hypertension and cerebral infarction,while only 5 patients in group 2.And 6 patients in group 1 and 15 patients in group 2 were associated with combined injury.Skin or bone traction were performed before surgery and low molecular heparin was administrated to prevent deep vein thrombosis of lower limbs.Medical consultations were needed for those medical diseases,while the symptomatic therapy is for compounded injuries.We did the operation approximately 3-10 days after injury,when the patient’s state is stable.All the patients were given closed reduction and PFNA fixed.The patient was in the supine position with the affected hip supported by soft pillow. Tract the lower limb of the affected side to reduce the fracture reduction. A 5 cm long incision was made on the skin at the peak of the greater trochanter, if the satisfied reduction was acquired. Insert the guide needle at the peak of the greater trochanter,expanding medullary cavity,and then inserting the PFNA into the proximal femoral medullary cavity along the guide needle. Installing the sleeve after the PFNA was inserted into the proper position under the observation of fluoroscopy. The measuring needle was inserted into the femoral neck.The position of the measuring needle was monitored by the fluoroscopy. And measure the femoral anteversion angle after making sure that the needle is in proper position.A special bracket is placed on the bianterior superior iliac spines,The top line of the bracket is parallel to that of bianterior superior iliac spine. Place a guide needle on the foot of the affected limbs, then rotate the foot and make the needle perpendicular with the banterer superior iliac spine. Taking photos with a digital camera at about 50 cm away from the foot side, measuring the angle formed by bianterior superior liac spines line and femoral needle in the photographs. This is called clinical femoral anteversion angle.The data is divided into two groups according to age, older than 65 years as group 1,age less than or equal to 65 years as group 2.Then perform a statistical analysis to all data.Results: Making statistical analysis on the data of measured femoral anteversion angle, the anteversion angle of age older than 65 years old group is 20.3°±4.2°, while age less than 65 years old group is 29.8°±4.0°, These two groups have statistical significance( P< 0.05). The average age group of age older than 65 years old is 77.3±5.7 years, while the group of age less than 65 years old is 48.9±12.3years, which has statistical significance( P< 0.05).Conclusion: The femoral neck anteversion angle is various.As the age increasing,the emoral neck anteversion angle gradually decreasing. There fore,clinical orthopedic surgeons have to know the tendency of the anteversion angle of patients,which means when doing intertrochanteric fractures,he direction of the guide needle varies with age:young patients should have large puncture angle,while the old patients should be a little smaller, Through this way we can increase the accurate of the needle,shorten the operation time, avoid failure of the surgery. |
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