Retrospective Study On Indicators Related To The Operation Of Pathological Fractures On Shaft Of Appendicular Long Bones With The Treatment Of Intramedullary Nail And Plate Fixation

Objective: To analyse the characteristics of pathological fractures on shaft of appendicular long bones and indicators related to operation in our hospital in addition to the advantages and disadvantages of different surgical methods;To discuss the choice of the ways of surgery for pathological fracture preliminarily,and to provide references for surgical treatment of pathological fracture.Methods: According to the given index terms,this paper has retrieved the patients with surgical treatment of pathological fractures in the case retrieval system of the first hospital affiliated to Dalian medical University from January 2008 to December 2015 and read the medical records of each patient carefully in order to select the cases what we need.According to the given inclusion and exclusion criteria,finally,58 cases were screened out satisfied the criteria for this study.Patients in accordance with the inclusion criteria were divided into groups of humerus and femur.The patients in each group were divided into two subgroups according to the different operation methods,and the patients were divided into steel plate internal fixation and intramedullary nail fixation.Make the case report form and collect patient demographic information,basic diseases,operative time,estimated blood loss,intraoperative blood transfusion,preoperative and postoperative hemoglobin,pathological fracture time,tumor pathological diagnosis and so on,and among the subgroups patients basic information and related statistical parameters were analyzed.we compare the difference between the amount of bleeding and operative time respectively by student 't test between the two subgroups in each group,and whether there is statistical significance or not.Among them for comparison of the intraoperative blood loss,we selected two calculation methods(bleeding direct estimation method and dynamic difference of hemoglobin method)to verify the accuracy.Results: 1.Baseline information results: by the case retrieval system,58 patients with surgical treatment of extremity pathological fractures were collect,cases of each group number,operation style,age,gender,height,weight and other baseline data were statistically compared the baseline characteristics,and their baseline data is consistent.2.comparison on operation time in the same fracture site under two kinds of surgical mode: operation time of humeral patients that underwent intramedullary nail internal fixation was longer than that underwent plate internal fixation,and operation time of femoral patients that underwent intramedullary nail fixed was shorter than that underwent plate internal fixation,but there was no statistically significant difference two groups(P > 0.05).3.comparison on the value estimation of intraoperative blood loss: the value estimation of intraoperative blood loss of humeral patients that underwent intramedullary nail internal fixation was more than that underwent plate internal fixation,the value estimation of intraoperative blood loss of femur patients that underwent intramedullary nail fixed was less than that underwent plate internal fixation,but there was no statistically significant difference two groups(P > 0.05).4.Indirect calculation of intraoperative blood loss by dynamic hemoglobin estimation: intraoperative blood loss of humeral patients that underwent intramedullary nail internal fixation was more than that underwent plate internal fixation,intraoperative blood loss of femoral patients that underwent medullary nail fixation was also more than that underwent plate internal fixation,but there was no statistically significant difference two groups(P > 0.05).Conclution : 1.intramedullary nail fixation and steel plate internal fixation both can be as surgical methods on pathological fractures on appendicular long bones.Although intraoperative blood loss had no significant difference in statistics,but the amount of bleeding of patients that underwent intramedullary nail fixation was more than that underwent steel plate internal fixation,which can provide reference for the choice of operative methods in clinical practice.2.Although there was no significant difference in the operation time,the two kinds of operation methods still had the difference in different parts of the fracture.In clinical practice,the choice of surgical method should be comprehensively considered basing on the specific location of the fracture,the scope of the lesion,the degree of bone destruction,the nature of the tumor,the life expectancy of patients and the characteristics of the implants and other aspects.