| Objective:1.To explore the accuracy of pre-design spiral blade incision of PFNA with the body surface localization by the span of thumb and index finger from patient.2.To make clear superiority about the body surface localization,which provides a more simple and minimally invasive surgical strategy for the complicated intertrochanteric fracture.Methods:1.From June 2015 to January 2016,35 patients with stable intertrochanteric fracture were treated with PFNA internal fixation.The general data of the patients included patients' sex,age,AO fracture type,and preoperative body mass index.The distance of L1 was the span of thumb and index finger from patient,while the distance of L2 was the span of thumb and index finger from surgeon.The anterior superior iliac spine(ASIS)was a center,with a radius of L1,the intersection of the arcs and the femoral lateral centerline,which was recorded as a point of A.The anterior superior iliac spine(ASIS)was a center,with a radius of L2,the intersection of the arcs and the femoral lateral centerline,which was recorded as a point of B.The insertion point of actual spiral blade was recorded as point of O during the operation,and measure the distance of OA,OB and L,whose the distance between the ASIS and the point of O.By statistical analysis to show the accuracy that pre-design spiral blade incision according to the span of thumb and index finger from patient.2.From January 2016 to December 2016,80 patients with unstable femoral trochanteric fractures who met the inclusion and exclusion criteria were randomly divided into routine operation group and surface localization group.Traction and open reduction under fluoroscopy was implemented in routine operation group.The patients in the body surface location group,whose spiral blade incision of PFNA were designed by the span of thumb and index finger.And the incision was used to auxiliary reduce fracture,while the nail can be placed at the same time.The related data,including operation time,incision length,the total fluoroscopy times,bleeding volume,the quality of fracture reduction,fracture healing time and Harris scores at 3 months after operation,were used to evaluate the clinical effect.Results:1.The distance of L and L1,had no statistical significance(P>0.05).The average level of OA and OB,had a statistical significance(P<0.05).The point of A was more close to the point of O,which showed more accuracy by the span of thumb and index finger from patient to position spiral blade incision of PFNA.2.It can be carried out strictly according to the treatment plan and complete data collection in 65 cases,30 cases in conventional surgery group and 35 cases in body surface localization group.There was no statistically significant in the sex,age,AO fracture type and preoperative BMI.There was statistically significant in length of incision,the amount of bleeding,the number of total fluoroscopy,quality of fracture reduction and the fracture healing time between the two groups(P<0.05).There was no statistically significant in the operation time and Harris scores at 3 months after operation between the two groups(P>0.05).Conclusion:1.The span of thumb and index finger from patient can be used as the basis for pre-design spiral blade incision.2.The body surface localization,which is the span of thumb and index finger from patient to pre-design spiral blade incision,provide a new auxiliary incision for the minimally invasive operation of the complicated intertrochanteric fracture.It is worthy of clinical application and promotion.3."Three joint incisions",cutting the main nail and spiral blade incision in advance and necessary anterior incision by the body surface localization,can realize complex intertrochanteric fracture under dynamic effective reduction,using the same incision accurately implant internal fixation materials.What's more,it can avoid unnecessary incision,extra radiation and excessive soft tissue injury.Thus,minimally invasive surgery can be achieved. |
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