Trabecular Width On The Fixation Of Intertrochanteric Fractures Of Choice

Objective:To investigate the anatomical specimens intertrochanteric trabecular bone mineral density count ratio and plain film by DR to estimate bone strength, and then compared against the clinical efficacy of proportion, draw the corresponding threshold, to guide the choice of future implant. Intertrochanteric fractures in order to improve the cure rate and reduce the probability of failure within the plant. For the clinical treatment of choice to provide the appropriate basis.Methods:By calculating the preoperative DR plain film chose the width ratio of the trabecular bone and clinical artificial joint replacement surgery out of the proximal femur anatomical specimens observed after vertical power saw and found that trabecular bone width of less than 1:0.55 specimens Autopsy by the power saw the lower part of the femoral head tilted sideways deformation of trabecular bone. Then selected the clinical previous cases which were reviewed studies. Selected China-Japan Friendship Hospital, Jilin University, Department of Orthopaedics in September 2009 to September 2010 using locking plate fixation, artificial joint replacement of two surgical treatments for elderly patients with intertrochanteric fractures of 72 patients, which ages were 70 to 80 years old, and including 38 males and 34 females, male to female ratio of 1:1.118. The average age was 79.4 years. The causes of injury:62 cases of accidental falls,10 patients with minor bruises. All the cases are the fresh fracture. According to Evans the fracture classification:I-6 cases,â…¡in 14 cases,â…¢A in 12 cases type,â…¢B type in 20 cases,â…£type 20 cases, V-0 case. Artificial joint replacement group were 34 cases and internal fixation group were 38 cases. The out-patient reviewed and telephone followed-up 6 months to 3 years. Average was 18 months. Artificial joint replacement group and DHS fixation group of patients age, gender, fracture type, operative time, intraoperative and postoperative blood transfusion were recorded. Patients follow-up shimoji time, hospitalstay and postoperative complications, preoperative and postoperative Harris scores and poor, Comparison of two treatment methods for evaluation and for statistical analysis.Results:The operation time of artificial joint replacement group was 55-130 minutes, with an average 95.76 minutes, and intraoperative and postoperative blood transfusion 200-800ml, an average of 520ml;The operation time of locking plate fixation was 65-165 minutes, with an average 103.42 minutes, and intraoperative and postoperative blood transfusion 0-1400ml, an average of 475ml. Time of surgery, respectively, t test (see Table 3), intraoperative and postoperative blood transfusion on the rank sum test, locking plate fixation in patients with artificial joint replacement was not statistically significant between the two. Postoperative follow-up results:of joint replacement group can sit up in bed regularly 2-3 days after operation, started exercising in bed 5-7 days later, walking with walking aids after 1 week, ambulation and weight-bearing activities time was 1-11 weeks, with an average of 4.6 weeks. Activities time of fixation group away from the bed was after 8-16 weeks, the average was 12.0 weeks. In the postoperative complication, locking plate group had two cases of deaths in internal diseases, two cases of urinary tract infection, two cases of limb deep vein thrombosis, four cases of loosening of internal fixation; The artificial joint replacement group had only one case of consciousness and abnormal limb deep venous thrombosis, and improved after treatment. The incidence of postoperative complications were carried out on the X2 test, T test in bed time, T test days of hospitalization, compared with Harris score decreased values after operation, they have statistical significance.Conclusion:The width ratio of trabecular bone in 1:0.55 following intertrochanteric fracture, artificial joint replacement group compared with locking plate fixation group a short time in bed, fewer postoperative complications, and better postoperative functional recovery. Arthroplasty was one of the options for the treatment with the trabecular bone width of less than 1:0.55 of intertrochanteric fracture. If more than the recommended width of the line in its locking plate fixation, to preserve the proximal femur. To provide a reference for clinicians in the treatment of intertrochanteric fracture with fixation choice.