| 1. The biomechanical comparative study of DHS,PFNA and Gamma3 for treatment of the intertrochanteric fracturesObjective : To study the biomechanical function of different internal fixations of the intertrochanteric fractures and to provide the scientific evidence of the valid fixing methods for clinical choice .Methods : The 18 fresh specimen of proximal femur were made into the intertrochanteric fracture models , which were fixed with the following fixation devices : dynamic hip screw (DHS), the third generation Gamma nail (Gamma3) and the proximal femur nail antirotation(PFNA).Then the different internal fixation methods were tested and proved by means of experiment press analysis.Results : The experiment press analysis proved that the biomechanical function of Gamma3 and PFNA was better than that of DHS in the following aspects(P<0.05) : load-strain,load-displacement,load-axial compression,load-axial rigidity ,load-shear rigidity ,torsion moment-torsion angle and fixation failure under static loading.There was no obvious difference between Gamma3 and PFNA(P>0.05).Conclusion : It is a good way of the third generation Gamma nail (Gamma3) and the proximal femur nail antirotation(PFNA) to treat the intertrochanteric fractures at present, which has the advantages of solid fixation and good biomechanical function .2. The clinical applied study of DHS,PFNA and Gamma3 for treatment of intertrochanteric fracturesObjective:To compare surgical trauma, complications and the clinical curative effects of DHS,PFNA and Gamma3 for treatment of intertrochanteric fractures.Methods: 392 cases of intertrochanteric fractures of femur admitted from January 2006 to December 2009 were reviewed. All cases were divided into three groups:group one was treated with dynamic hip screw (DHS),group two was treated with proximal femoral nail antirotation (PFNA) and group three was treated with the third generation Gamma nail (Gamma3).160 patients were treated by DHS which involved 76 males and 84 females,with the average age 69.2 years. Mode of injury:traffic accident in 15 cases,fall from height in 7 cases and fall at home in 138 cases.AO classification:A1 type in 54 cases,A2 type in 89 cases,A3 type in 17 cases.157 cases were treated by PFNA which involved 69 males and 88 females,with the average age 72.4 years. Mode of injury:traffic accident in 17 cases,fall from height in 4 cases and fall at home in 136 cases.AO classification:A1 type in 39 cases,A2 type in 94 cases,A3 type in 24 cases. 75 cases were treated by Gamma3 which involved 32 males and 43 females,with the average age 73.7 years. Mode of injury:traffic accident in 5 cases,fall from height in 1 case and fall at home in 69 cases.AO classification:A1 type in 19 cases,A2 type in 44 cases,A3 type in 12 cases.Analytic comparisons were then conducted to study the difference between the three kinds internal fixations,including operation time, blood loss during operation,the incidence of complications of intraoperation or postoperation,bony union time and the function changes of hip joint.Result: After operation,392 cases were followed up from 3 to 48 months with 21.9 months on the average. The function of the hip joint was evaluated with the Harris hip score.1) The averaged intraoperative bleeding was 264.5±85.3ml(ranged from 100ml to 800ml) and the averaged operation time was 67.6±18.4min(ranged from 50min to 180min) in the DHS group. The averaged intraoperative bleeding was 103.6±61.7ml(ranged from 30ml to 500ml) and the averaged operation time was 52.7±11.5min(ranged from 30min to 150min) in the PFNA group. The averaged intraoperative bleeding was 145.8±68.6ml(ranged from 50ml to 400ml) and the averaged operation time was 58.3±14.1min(ranged from 30min to 110min) in the Gamma3 group. There was a statistically important difference in the mean blood loss between the three groups(P<0.05).There was no significant difference in the mean operation time between the three groups(P>0.05).2) The incidence of complications related with internal instrument were 24.7% in the DHS group,7.0% in the PFNA group and 4.0% in the Gamma3 group.There was a statistically important difference between the DHS group and the PFNA group(P<0.05). There was a statistically important difference between the DHS group and the Gamma3 group(P<0.05).There was no statistically difference between the PFNA group and the Gamma3 group(P>0.05).3) The bony union time was 13.5±1.7 weeks in the DHS group,12.8±1.0 weeks in the PFNA group and 12.3±1.2 weeks in the Gamma3 group.There was no statistically difference between the three groups(P>0.05).4) The function changes of the hip joint of the PFNA group and the Gamma3 group in earlier period was better than one of the DHS group.There was no obvious difference in the function changes of the hip joint in the long-term between the three groups. The excelent and good rate of the hip joint function after surgery were 86.4% in the DHS group,89.1% in the PFNA group and 90.2% in the Gamma3 group,there was no statistically difference(P>0.05).Conclusion:1) There is not evident difference in the long-term clinical effects of the three groups.The patients using the PFNA and Gamma3 can achieved immediate full weight- bearing,which can decrease the incidence of the complication duration of hospital stay.So the pristine clinical effects in the patients using the PFNA and Gamma3 is better than the pristine clinical effects in the patients using the DHS.2) There is no obvious difference in the incidence of complications of the treatment of the type-A1 intertrochanteric fractures using DHS,PFNA and Gamma3,then the three methods of the internal fixation can be first choosed for the type-A1 intertrochanteric fractures.The incidence of complications of the treatment of the type-A2 intertrochanteric fractures using DHS is higher than one of the treatment of the type-A2 intertrochanteric fractures using PFNA and Gamma3,so the treatment of the type-A2 intertrochanteric fractures using DHS isn't recommended. DHS isn't applied for the type-A3 intertrochanteric fractures,because the incidence of complications is 64.7%.3) The PFNA and Gamma3 can shorten the operation time, evident lessen blood loss of intraoperation,be little trauma for the patients,supply firm fixation for all fracture types,reduce the incidence of complications intraoperation and postoperation.The PFNA and Gamma3 were idle implant for treatment intertrochanteric fractures,especially were first choosed for the osteoporotic patients of type -A2 or type-A3 intertrochanteric fractures. |
PDF Full Text Request