| Objective:With a wealth of accelerated population aging and the elderly outdoor activities, injury accident occurred increased risk, femoral intertrochanteric fracture incidence increased year by year, the improvement of the level of social life, with diabetes proportion also increasing, on recovery satisfaction with how to choose a reasonable mode of operation and improve the operation for femoral intertrochanteric fracture after increased the difficulty. Femoral intertrochanteric fractures in elderly patients with a high risk of fracture displacement, high proportion of hip inversion, and more complications after trauma, high mortality rate. Therefore, intertrochanteric fractures of the elderly more than the use of internal fixation, and at present the proximal femoral nail anti rotation Proximal nail anti- rotation(femoral) is the most widely used. PFNA fixation is typical of intramedullary fixed in the center of the system, can be a good control center shift, resistance strong bending shear stress, main nail 6 DEG angle with proximal femoral anatomical characteristics, also have static and dynamic double lock mode. For the elderly patients with diabetes, the high blood glucose intervention bone callus growth, increase the incidence of postoperative complications, and ultimately affect the fracture healing. The correlation between blood glucose and fracture healing time in elderly patients with intertrochanteric fractures were reported in the literature, but the influence of different levels of blood glucose control on fracture healing time was rarely reported at home and abroad. Therefore, the effect of fasting blood glucose control on fracture healing is still not determined. Through the study of non diabetic patients with and without previous have diabetes blood glucose control level of different, in femoral coarse intertrochanteric fracture PFNA fixation of fracture healing of the duration of the observation, so as to explore glycemic control in what range of fracture normal healing effect was not statistically significant, for the selection of surgery and postoperative rehabilitation effective basis and treatment recommendations.Methods:In our hospital from March 2011 to December 2015, 328 cases of femoral intertrochanteric fractures were treated with PFNA internal fixation, and finally according to the blood glucose level, 109 patients were selected for the study. According to fasting blood glucose levels were divided into 3 groups: 38 cases of non diabetic group, 1 cases of diabetes(fasting blood glucose control in 6.1-8.0mmol/L) 35 cases, 2 cases of diabetes(fasting blood glucose control in 6.1mmol/L) 36 cases. Fasting blood glucose was mainly used in the first two days of the average blood glucose level. There were no significant differences in gender, weight, age and other general data between the 3 groups(P>0.05). Improve the examination before surgery, adjust the blood sugar level to 8.0mmo1/L below, the indicators to meet the requirements of the operation, the signing of the consent of the book. All patients were treated with PFNA internal fixation, and all patients underwent combined spinal epidural anesthesia. Postoperative ECG, blood oxygen saturation, blood pressure monitoring for 24 h, 2 liters of oxygen / points, after the operation immediately and postoperative the 2 day review of blood, emergency1+2, according to the index of blood transfusion, supplement of electrolyte, after operation except for routine inspection and functional exercise, 3-7times daily blood glucose monitoring is early, dinner, before a meal after midnight zero blood glucose levels, according to the monitoring of blood glucose level adjusting the dose of insulin or oral drug dose. And in the immediate postoperative films, after 4, 12,24 weeks of follow-up outpatient shoot hip side position piece, according to the hip joint is lateral radiographs callus evaluation method,4,12and24 weeks after operation, fracture healing is divided into 4 different levels and I, II, III, IV according to X-ray assessment were counted as 1, 2, 3, 4 points, then integral by statistical analysis.Results:Of the 328 patients who meet the conditions in the end as the study of 109 cases, follow-up time 13-57 months, average 28.5months, all use SPSS19.0 to complete statistical analysis, three groups of cases in all patients 24 weeks were completely healed. The average fracture healing time was: the non diabetic group was 12.67+1.32 weeks, the 1 groups were 15.23+2.15 weeks, the 2 groups were 15.62+2.75 weeks. X-ray score by rank sum test. Among the three groups of pairwise comparisons showed that: non-diabetic group and diabetes group, diabetes and non diabetes group 2 between group difference has statistical significance; diabetes mellitus group 1 with diabetes between the two groups by comparison, P>0.05, the difference was not statistically significant.In the 12 weeks after the operation, most of the cases achieved grade III healing, of which 3 cases of non diabetic group healed, 32 cases of grade III healing, 3 cases of grade IV healing. In 1 and 2 groups, 29 cases achieved grade III healing, 1 cases achieved grade IV healing, and the others were grade II healing. No patients with grade I healed in 12 weeks. In the 24 week after operation, all cases achieved grade III or above, and no grade I or II. Among them, 7 cases of non diabetic group reached grade III healing, 31 cases of grade IV healing, 12 cases of diabetes mellitus 1 cases of grade III healing, 23 cases of grade IV healing, 14 cases of diabetes 2 cases achieved grade III healing, 22 patients achieved grade IV healing. 12 weeks, 24 weeks of non diabetes group than the other two groups were statistically significant differences(P < 0.05), and the difference between the diabetic group was not statistically significant(P > 0.05).Conclusion:The fracture healing time of the patients with femoral intertrochanteric fracture after PFNA fixation was longer than that in the non diabetic group, and there was no significant difference in the healing time between 6.1-8.0mmol/L and 6.1mmol/L. Therefore, in the early stage of diabetes or not suffering from diabetes, should be active missionary, as far as possible to reduce the prevalence of diabetes. For patients who have been diagnosed with diabetes, femoral intertrochanteric fracture PFNA internal fixation of perioperative blood glucose control within 8mmol/L, fracture healing time can achieve the desired results. |
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