| Objective:Elderly through the surgical (LCPandDHS) treatment of 67 cases of intertrochanteric fracture patients, To investigate the treatment of intertrochanteric femoral fracture method of choice for clinical work to make some theoretical guidance.Methods:Select the Japan Union Hospital of Jilin University Orthopedics January 2005 to October 2010 during the intertrochanteric fracture patients aged 67, were studied retrospectively analyzed. Agree to accept those LCP fixation for the treatment group received DHS fixation as the control group. Treatment of 33 patients,12 males and 21 females, aged 65-90 years, mean 78 years. Injured side:the left side in 12 cases,21 cases of right. Fracture type classification according to Evans:I Type II Type 10 cases 12 cases,2 casesⅢⅣⅤtype 6 cases,3 cases. Cause of his injuries:22 cases of falls,11 cases of car accident injuries. Preoperative medical complications in 15 cases, multiple fractures in 2 cases. Postoperative nonunion in 1 case, broken plate in 1 case, venous thrombosis in 1 case. Because of preoperative cerebral thrombosis,6 patients after surgery has been bedridden. Control group,34 patients,13 males and 21 females, aged 65-82 years, mean 72 years. Injured side:17 cases left, right,17 cases were 0 cases of bilateral fractures at the same time. Fracture type classification according to Evans:I II in 13 cases 13 cases 5 cases III IV V type 2 cases 1 case. Cause of his injuries:24 cases of falls,10 cases of car accident injuries. Preoperative medical complications in 8 cases of multiple fracture in 1,1 patient died after operation,4 cases of deep vein thrombosis. Because of preoperative cerebral thrombosis,2 patients after surgery has been bedridden. Were followed up for 5 months to 5 years, an average of 23 months. Assessment of the operation time, blood transfusion, patients were followed up for postoperative complications, postoperative hip function, and functional assessment by harris hip function evaluation criteria.Patient admission, detailed history taking the patient to understand the injury and illness through. Careful examination. Exclusion combined with other organ injuries. Special attention to elderly medical history. Admitted to hospital for routine laboratory tests and imaging. According to preoperative imaging data and the body to formulate a treatment plan accordingly. For older patients, multiple co-existence of different degrees of medical illness, will call on physician consultations, if the medical problems are serious, temporarily unable to surgery, may be given skin traction braking, aggressive treatment of coexisting diseases. Preoperative status of patients with systemic adjustment. Including the adjustment of blood volume, heart and lung function and kidney function, its enough to withstand surgery. Routine prophylactic antibiotics before surgery to prevent postoperative infection.In Japan Union Hospital of Jilin University in the operating room for surgery, according to the patient's body to choose general anesthesia or epidural anesthesia.Treatment group (LCP group):33 cases, the patient supine on the operating bed, elevate the affected side of the hips 20cm. Incision above the greater trochanter to take 2cm, the lateral extension of the distal femur along the 10cm or so, cut the skin layer by layer, subcutaneous tissue, fascia lata to expose the vastus lateralis muscle and the muscle attachment in the Ministry of the greater trochanter, along the After the muscle incision proximal direct periosteum to expose the femur below the greater trochanter and the lateral bone surface. Manipulative reduction traction first in the C-arm X-ray machine perspective anteroposterior and lateral position is better, far away from the greater trochanter at the top of the right place about 0.5～1 cm length of LCP, place the satisfaction of the drill screw holes and screws by gold plate. Head and neck tension with three screws. If lesser trochanter fractures, screw or wire fixation can fracture block. Further C-arm X-ray machine check reset and fixed, fixed satisfied, can be thoroughly washed and sutured incision.The control group (DHS group):34 cases, the patient supine on the operating bed, elevate the affected side of the hip 30°. The ipsilateral femoral greater trochanter as a starting point to do lateral longitudinal incision, about 15cm, cut the skin layer by layer, subcutaneous tissue, fascia lata and the vastus lateralis muscle, periosteal stripping exposed below the greater trochanter and lateral femoral bone surface. Manipulative reduction in the C-arm X-ray machine lateral and anteroposterior perspective, position satisfaction of the vertices in the greater trochanter at the bottom of 2-2.5cm, with 135°neck shaft angle positioning device positioning, drill into the guide pin, with C-arm X-ray guided needle penetrating examination of the length, position satisfaction of the guidewire into the measurement of the length of the bone channels open, tapping, screw lag screw, and then install the steel sleeve, having a good end of nails. Plate followed by the other holes are drilled, tapped and screwed into the screw by gold plate. For small tuberosity fracture, and can be installed before the wire fixed DHS can also be used compression screw cancellous screw holes through the plate at the top of two blocks of the small tuberosity fracture fixation. With C-arm X-ray machine check reset and fixed the situation, the satisfaction of thoroughly washed incision, the incision was sutured.Results:DHS group operative time was shorter than the LCP, was statistically significant (p <0.05); blood transfusion group and the LCP group on the DHS was no significant difference was not statistically significant (p> 0.05); LCP group after The incidence of complications with the DHS group of the same, was not statistically significant (p> 0.05); according to Harris hip score after surgery group compared with the DHS group LCP joint function was not statistically significant (p> 0.05).Conclusion:1. Elderly patients with intertrochanteric fractures associated with osteoporosis and more, especially in comminuted fracture occurs, DHS and the LCP comparison, should be preferred LCP.2. Intraoperative femoral reconstruction from whether it relates to surgical success or failure. Femoral reconstruction from the functional recovery of patients is important. |
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