| BackgroundThe technique of anti-rotation femoral proximal intramedullary nailing(PFNA)is a new type of proximal femur internal fixation system,which is improved from the proximal femoral nail system.On the one hand,it inherits the advantages of PFN and has the same biomechanical stability.On the other hand,some innovations have been made in the specific design to make the fixation more secure,more adaptable,and easier to operate.Now it is becoming popular and becoming the mainstream internal fixation technology for treating fractures between the femoral neck and the trochanter.Titanium cables are used to fix the fracture blocks by binding.It has also been widely used in the fixation of long bone oblique and longitudinal split fractures of extremities.The position of the small trochanter is deep,it is difficult to be exposed,and the reduction and fixation are not easy.Whether or not this fracture of the combined trochanter requires reduction and fixation of the small trochanter,There are still some controversies in clinic.This paper attempts to treat intertrochanteric fracture with small trochanter fracture by using the technique of anti-rotation intramedullary nail(PFNA)combined with titanium cable fixation,and fix the small trochanter with titanium cable.In order to promote the healing of small trochanter and improve the clinical effect of intertrochanteric fracture with small trochanter fracture.ObjectiveThis paper attempts to use the technique of anti-rotation proximal femoral intramedullary nail(PFNA)and titanium cable to fix the small trochanter to treat Evans-Jensen IV-V-type intertrochanteric fracture with small trochanter fracture.To investigate the clinical effect of the treatment of intertrochanteric fractures with femoral proximal femoral intramedullary nail(PFNA)combined with titanium cable fixation for intertrochanteric fractures.The clinical effect of PFNAs was compared with that of traditional antirotation proximal intramedullary nail(PFNA).MethodThe clinical data of 56 cases of Evans-Jensen IVV intertrochanteric fracture with small trochanter fracture treated in Henan Provincial people's Hospital from January 2015 to September 2016 were retrospectively analyzed.In the treatment group,26 cases(12 males and 14 females)were treated with PFNA-anti-rotation proximal intramedullary nail(PFNA)combined with titanium cable fixation(n = 26).The average age was 69.4 years(mean age 69.4 years).The follow-up period was 12-16 months,with an average of 14.4 months.Traditional treatment group(non-fixed trochanter group)using the technique of anti-rotation proximal femoral intramedullary nailing(PFNA-treated group)30 cases,14 male and 16 female,average age of 70.8(years),followed up for 13-16 months,mean 14.6 months.The two groups were treated with skin traction or femoral condyle flexibly,tibial tubercle traction,correction of limb shortening,and active treatment of internal medical diseases before operation.The X-ray,CT plain scan and three-dimensional reconstruction were performed before the operation.The line direction,the fracture line of the small trochanter and the direction of displacement for the intraoperative reduction and fixation for preoperative preparation,fully clear the type of fracture,all of which are Evans-JensenIV,V intertrochanteric fracture with small trochanter fracture.One major operation was performed with the same internal fixation instrument,and routine treatment was given after operation,such as prevention of infection,detumescence,pain relief,anticoagulant and bone healing.The time of operation and the amount of blood lost during operation were recorded,followed up and compared between the two groups.The incidence of postoperative complications(ectopic ossification)was compared and analyzed.At the last follow-up,the Harris hip joint function score was used to evaluate the hip function and the curative effect of the operation.The evaluation criteria of "excellent" were as follows: the pain of hip joint disappeared completely,the function returned to normal,the deformity of the affected limb disappeared,and the range of motion of hip joint returned to normal,and the evaluation standard of "good" was as follows: Occasional hip joint pain,limb function is basically normal,lower extremity deformity is obviously improved,the range of hip joint movement is close to normal.The lower extremity malformation still exists,the range of motion of hip joint is larger than that after operation,but still can't reach the normal range,the evaluation standard of "bad" is that the pain of hip joint still exists,the function recovery is not obvious,and the deformity of lower extremity is not improved.The range of hip joint motion is still severely restricted.ResultThe operative time was 41.7 ±8.8 min and the intraoperative bleeding was 115 ±18.5 ml in the combined titanium cable fixation group,and 30 cases in the unfixed small trochanter group.The operative time was 34.5 ±9.7 min and the intraoperative bleeding volume was 103 ±19.2 ml.There was no significant difference in the operative time and the intraoperative blood loss between the two groups compared with the non-fixed trochanter group(P > 0.05).The time of landing was 6.1 ±0.5 weeks in the combined titanium cable fixation group and 7.7 ±0.6 weeks in the unfixed small trochanter group,and 6 cases in the combined titanium cable fixation group,and the lower ground time in the combined titanium cable fixation group was lower than that in the non-fixed small trochanter group.The incidence of complications was lower and the difference was statistically significant(P < 0.05).The Harris hip function score was 89.67 ±3.37 in the combined titanium cable fixation group and 80.24 ± 4.18 in the non-fixed small trochanter group at the last follow-up.The Harris hip function score was higher in the combined titanium cable fixation group.The difference was statistically significant(P < 0.05).ConclusionCompared with the traditional technique of anti-rotation intramedullary nail(PFNA)and titanium cable fixation,the operation time and the amount of intraoperative bleeding did not increase significantly(the difference was not statistically significant)compared with the traditional technique of anti-rotation proximal femoral intramedullary nail.And the patient gets off the ground early,The postoperative complications are less,and the hip joint motion and function recover well,which can better meet the daily life needs of the modern elderly patients.To sum up,based on the more and more developed medical technology,more and more controllable intraoperative risk,as well as the elderly patients with higher hip function requirements and expectations,anti-circumflex proximal femur The intramedullary nail technique combined with titanium cable fixation of the small trochanter is a more effective and satisfactory surgical method for the patients.It is worthy of study in large clinical samples and worth popularizing in more hospitals and orthopedic physicians. |
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