| Objective:Intertrochanteric fracture is very common in clinic.The fracture mechanism is usually caused by direct or indirect rotation of the femur.Because most elderly people have osteoporosis,so by direct or indirect violence of the elderly are more prone to this type of fracture.Such as the incidence of high incidence of osteoporosis in elderly patients,because of the complex anatomy of the proximal femur and the complex stress and shear force of the femoral intertrochanteric,it brings great difficulty to the clinical treatment.In the treatment of this type of fracture,strict and effective internal fixation is the treatment of intertrochanteric fracture criterion.At present,there are many kinds of methods,which can be divided into two categories:intramedullary fixation and extramedullary fixation.For example,extramedullary fixation with dynamic hip screw(DHS)and proximal femoral anatomical plate etc.Intramedullary fixation such as proximal femoral nail(Gamma nail),proximal femoral nail(PFN),proximal femoral intramedullary nail(PFNA)etc.In the PFNA treatment of intertrochanteric fracture surgery,the advantage of femur two screw design into a spiral blade,with anti rotation,with proximal locking features,femoral neck bone loss,stable fixation,greatly reduce the occurrence of complications,has become the current clinical preferred treatment of femoral intertrochanteric fracture.However,with the wide application of this technique,the poor position of the spiral blade has become one of the most common complications after surgery.Therefore,it is necessary for us to design a device which can be used to accurately insert the spiral blade into the femoral neck.This study is to explore the accuracy and feasibility of screw-blade implanted auxiliary positioner in the treatment of intertrochanteric fractureswith PFNA.Methods:From January 2015 to December 2016,select 40 patients with intertrochanteric fracture of the femur.Among them,they were 13 males and27 females.Their ages ranged from 65 to 83 years,with an average of 77.2years.According to the Evans classification of intertrochanteric fracture of femur,3 cases were type I,type II,type III,type III in 10 cases,type IV in 8cases,type V in 13 cases.According to the double-blind method,divided into control group(group A)and observation group(group B).Age,sex,fracture types were comparable,and there was no statistical difference.The first 20 patients in the control group(group A),received conventional surgery by proximal femoral nail anti-rotation(PFNA).After 20 patients in the observation group(group B),received PFNA surgery with screw-blade implanted auxiliary positioner.The patients were placed in supine position after satisfactory spinal anesthesia.With the help of the C arm X,traction reduction of the fracture.Disinfection operation area,need to be exposed to the groin.After the completion of preoperative preparation,make a 3~4cm incision at the apex of the trochanter.Separate the subcutaneous tissue and fascia lata gradually,showing greater trochanter of femur.In the piriform fossa of the femur,as the opening point,insert the guide pin under fluoroscopy.At this point,the assistant slightly adduction limb,in order to ensure that the guide pin will not penetrate the medial femoral cortical bone.After the length is right,make sure that the guide pin in the femoral medullary cavity.Then insert the main screw into the femoral medullary cavity.After determining the location of the main screw,Connect side sight block.Then installing the screw-blade implanted auxiliary positioner on the side sight.Make the "U" type groove of screw-blade implanted auxiliary positioner stuck side sight block.And in order to prevent the instability,the bolt under the "U" type groove must be locked in side sight block.Make a 0.5cm incision in the groin skin and Insert the locating rod at the incision.Separate the subcutaneous soft tissue bluntly.By adjusting the angle of the front and back of the main screw,ensure that the vertical positioning rod against the femoral neck cortex.At this time,the screw blade implanted auxiliary positioner and the screw blade casing could form a rectangle.In the rectangle,the long axis of the femoral neck coincides with the spiral blade casing,and the direction of the screw blade is consistent with the central axis of the femoral neck.At the same time,the implanted auxiliary positioner eliminates the influence of the anteversion of the femoral neck on the implantation of the spiral guide plate,and can directly penetrate into the screw blade.Then implant the distal locking screw and install the tail cap of the main nail.The duration time of operation,the times of C-arm X-ray exposure and the times of implantation were recorded.After surgery,the patients were treated with standard lateral radiographs of the femur.And analysis the accuracy by measuring the angle of deviation between the screw axis and the central axis of femoral head.Results:A group of 20 patients with intertrochanteric fracture duration time of operation was 56.15 + 5.98 min,the times of C-arm X-ray exposure was20.35±2.21,and the times of implantation was 2.60±0.94.A group of 20 patients with a range of deviation angle of 6.75±3.24°.No screw blade cutting the femoral head phenomenon.B group of 20 patients with intertrochanteric fracture duration time of operation was 49.55±5.20 min,the times of C-arm X-ray exposure was14.70±1.89,and the times of implantation was 1.35±0.58.B group of 20 patients with a range of deviation angle of 2.80±1.44°.No screw blade cutting the femoral head phenomenon too.Conclusions:Screw blade implanted auxiliary positioner for femur intertrochanteric fracture,has obvious advantages.The utility model not only can obtain good reduction and fixation,but also can effectively prevent the occurrence of complications such as the cutting of the femoral head.Compared with conventional PFNA surgery,the combination of Screw blade implanted auxiliary positioner PFNA surgery has the following advantages.(1)The operation time was significantly shortened,mainly in the operation ofthe screw blade implantation.It could insert the screw blade into the best position of the femoral neck at one time,so as to avoid repeatedly adjusting the angle of the guide pin and reduce the operation time.(2)The times of C-arm X-ray exposure was reduced,which effectively reduced the radiation damage to the patients and surgeons in the C arm X system.(3)During the operation,the times of implantation was reduced,so the damage of the femoral neck bone mass was avoided due to the excessive number of times,And make the internal fixation more stable.(4)Postoperative X-ray showed that the deviation angle of femur was decreased.It is said that the position of the screw blade implanted into the femoral neck is more accurate and suitable.Thus,the holding force of the internal fixation is increased,and the cutting out of the femoral head is effectively avoided.(5)Because of the decrease of the operation time,the decrease of the X-ray exposure and the decrease of implantation,the patients’ bleeding and anesthesia time will be reduced accordingly.These will make the patients recover more quickly.This auxiliary positioner allow faster and more accurate implantion of the screw blade at one time.And it can significantly reduce the number of C-arm X-ray radiation,effectively reducing the radiation damage. |
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