| Objective: when treat intertrochanter fracture of femur using the measurement of PFNA internal fixation, statistical comparison and analysis of pressure of knee joints in PFNA implantation is implemented, to discuss the possible influence of knee joint cavity generated from closed reduction and internal fixation with PFNA.Methods: Patients with femoral intertrochanteric fracture who have been treated with PFNA internal fixation in the People's Hospital of Hunan Province from June, 2014 to December, 2015 are included in this study, among them, there are 34 males and 34 females aging from 67 to 88 with an average age of 78.5±2.5, all of them are divided into two groups according to ages, 25 patients at the ages from 67 to 74 belong to one group, and 43 patients from 75 to 88 belong to the other one, so as to compare the results between groups. Fractures are classified based on EVANS, type Ia 31 cases, type Ib 20 cases, type Ic 8 cases, type Id 6 cases, type II 3 cases. All whose operations are performed by the same surgeon using the same PFNA products and matching surgical instruments provided by Synthes Company. Pressure measuring device comprises a bone puncture needle, polyethylene tubing, SCW disposable pressure sensor and monitor. Before surgery, connect the pressure sensor to the monitor and other supporting systems, to output the central venous pressure(CVP) as the pressure value, connect the 0.01% heparin saline bottle to the pressure guiding tube through the three-way pipe and discharge the bubbles in the pressure guiding tube, adjust the monitor to 0 mmHg. Before the start of surgery, patients should be in the supination position with the knees bending at about 5 to 10 degrees, select anterior lateral margin of the patella as the point of needle insertion, then enter the knee joint cavity along the front of the patella with the needle NO.8, fill the cannula cavity and cannula mouth with heparin saline slowly, connect the needle with the pressure guiding tube quickly, the value of stable pressure is the pressure value of the knee joint. And then connect the pressure guiding tube to the atmosphere, which may help the pressure return to zero and make the pressure sensor be positioned at the same level as the puncture point. Under normal circumstances, there is a slight fluctuation in the baseline of the knee joint cavity, suggesting that the connection pipeline is unobstructed. The monitor starts to record pressure curve and data of knee joint cavity, until the end of PFNA surgery. The mean value and peak value of the knee joint pressure is recorded. If the linepipes are found to be blocked during measurement process, heparin saline can be opened to wash it.Results:After surgery, the number of patients with fluid in the joint cavity is 48, the amount of liquid is 10ml-68 ml, with an average of 35.3 + 2.4ml. Among them, 33 cases of patients with pale yellow liquid, 15 with pale red liquid. Under the microscope, 38 cases of patients' number of cells is below 1000/mm3, 8 cases of patients over 1000/mm3, and 2 cases of patients over 1500/mm3. The content of neutrophil cell is 60% to 74%. The joint fluid of 48 cases is more transparent, no turbidity, no coagulation, with a PH value of 7.31 to 7.37, averaging 7.321±0.121. The protein content is more than normal. Results of immunological examination, rheumatoid factor and antinuclear antibodies are negative. No bacterial and fungal infections are found in bacteria culture. The measurement results shows that the pressure of joint cavity increases in 56 cases, and 12 cases not, with an incidence of joint cavity pressure of 82.35%. When keeping supine position, knee joint cavity pressure values of 3.68 elderly patients with femoral intertrochanter fracture stay between 41.9mm Hg to 51.3mmHg with an average of 44.3±8.11 mmHg. The pressure values of the knee joint in patients aged between 75 to 88 years old are significantly higher than that in patients aged between 67 to 74 years old, the difference has statistically significance(P<0.05). When measuring the knee joint cavity pressure during PFNA internal fixation, 56 cases of patients with intra articular pressure has increased by a number between 7.2mmHg to 28.3mmHg with an average of 12.25±1.31 mmHg. The increase of the pressure values of the knee joint cavity in patients aged between 75 to 88 years old are significantly higher than that in patients aged between 67 to 74 years old, the difference is statistically significant(P<0.05); the increase of the pressure values of the knee joint cavity of the females are obvious higher than that of the males, the difference is statistically significant(P<0.05); the increase of the pressure values of the knee joint cavity of the patients whose marrow cavity diameter is 9mm than that in the patients whose marrow cavity diameters are over 9mm, the difference is statistically significant(P<0.05). 4. The patients whose pressure increase is over 10 mmHg have no evident difference(P>0.05) when being compared in the aspects of ages, genders and the diameters of marrow cavity. 5. When analyzing the correlation of ages, genders, marrow cavity diameter and fracture classification as the single factor for the pressure increase during PFNA operation of femoral intertrochanter fracture, the logistic regression analysis shows that, the factors of advanced age, female and smaller diameter of marrow cavity have higher correlation with the pressure increase of joint cavity.Conclusion: PFNA internal fixation in the treatment of femoral intertrochanteric fracture may be associated with the increase in the pressure of the knee joint cavity during operation and after operation. |
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