Impact Of Proximal Femoral Nail On The Anterior Femoral Cortex Impingement And The Choice Of Needle Insertion Point

OBJECTIVE To analyze the influencing factors of the proximal femoral short intramedullary nail and the anterior femoral cortex,and to seek the ideal needle insertion point of the intramedullary nail.Methods A retrospective analysis of 180 patients with femoral intertrochanteric fractures treated with proximal femoral nail fixation in the Department of Trauma and Orthopaedics of the Provincial Hospital of Anhui Medical University from January2010 to December 2016,including 65 males and 115 females;age 59 to 92 years old,with an average of 72.2 years old.Three orthopedic surgeons used a picture archiving &communication system(PACS)to magnify the lateral femur of the femur 6 times to observe the contact between the intramedullary nail tip and the anterior femoral cortex.The patient's gender,age,femoral anterior arch angle,BMI were recorded,and multiple regression analysis was performed on the above data of the impacted patients.The proximal femur was divided into anterior,middle and posterior portions on the femoral lateral radiograph to observe the intramedullary nail axis.Location and comparison of differences;according to the results of the study and further prospective study,from June 2017 to June 2018,the Department of Trauma and Orthopaedics of the Provincial Hospital of Anhui Medical University admitted to the "fast passage of the elderly hip fracture" patients in the femoral intertrochanteric There were 36 patients with fractures,including 9 males and 27 females,aged 62-96 years,with an average age of 78 years.They were randomly divided into group A,18 patients in the conventional treatment group.The anterior arch angle was measured after surgery.Group B test group 18 For example,group B underwent surgical treatment based on preoperative measurement of the anterior arch angle of the femur.The gender,age,anterior arch angle,operative time,amount of bleeding,and outpatient follow-up results of the two groups were recorded.Postoperative radiographs of the two hips and the positive side of the patient's femur were routinely evaluated to determine whether "impact" occurred and recorded.RESULTS In a retrospective analysis,in 180 cases of proximal femoral nails,106cases(impact rate 58.8%)occurred;31 males and 75 females;aged 65-92 years,mean73.4 years;femur Bow angle(12.1 ±1.4),BMI(33.6 ±1.8)kg / m2;analysis found that the size of the anterior arch angle,the choice of needle point is the influencing factors affecting the impact of the intramedullary nail and the anterior cortex of the femur,the former is mainly affected by Gender,age,and BMI factors.The incidence of impact in the first 1/3 of the proximal femoral needle insertion point was23.8%,which was lower than that in the middle 1/3(66.1%)and the latter 1/3(84.6%).In the prospective study,there was no significant difference in the general data,fracture healing time,and postoperative Harris score between group A and group B(P>0.05).There were significant differences in the operation time,intraoperative blood loss,postoperative VAS score,and postoperative intramedullary nail and femoral anterior cortical impact rate between the two groups(P<0.05).Conclusion: The difference between the impact of the proximal femoral nail and the anterior femoral cortex and the anterior arch angle is related to the choice of needle insertion.Gender,age and BMI are the main factors affecting the difference of anterior arch angle.Older obese women usually have larger Pre-femoral anterior arch angle,preoperative measurement of the anterior arch angle of the femur can effectively reduce the operation time,reduce the surgical trauma,reduce the incidence of postoperative impact,thereby reducing postoperative pain and reducing postoperative plant failure and false Complications caused by impacts such as fractures around the body.