ABSTRACT
Objective To examine the difference in the effectiveness between proximal femoral nail anti-rotation (PFNA) and femoral head replacement (FHR) of intertrochanteric fracture in elderly patients.Methods This study collected 69 patients that underwent PFNA or FHR after intertrochanteric fractures between June 2012 and September 2014.PFNA group was composed of 41 subjects (17 males and 24 females) aged 80-101 years (mean,86.7 years),and time from injury to operation was (3.12 ± 0.95)days.FHR group was composed of 28 subjects (13 males and 15 females) aged 80-99 years (mean,87.2 years),and time from injury to operation was (3.2 ± 1.0) days.Comparison of operation time,intraoperative blood loss,postoperative blood transfusion,off-bed time,complication incidence,hemoglobin concentration and hip function was made between groups.Results Duration of follow-up was 1-3 years (mean,1.8 years).Operation time and intraoperative blood loss in PFNA group were (46.8 ± 4.4) minutes and (77.0 ± 24.2) ml respectively,differed from (57.4 ± 5.9) minutes and (150.7 ± 46.5) ml in FHR group (P ＜ 0.05).Three days after operation,a similar decrease in hemoglobin concentration was seen in PFNA group [(21.3 ±6.1)g/L] and FHR group [(23.2 ±5.8)g/L] (P ＞ 0.05).Off-bed time in FHR group was (3.2 ± 1.2) days,shorter than (7.1-± 2.5) days in PFNA group (P ＜ 0.05).Incidence of postoperative complications in FHR group was 14％,lower than 37％ in PFNA group (P ＜ 0.05).Hip function of the two groups presented no significant difference six months after operation,but the proportion of excellent results in FHR group was higher than that in PFNA group (82％ vs.73％) (P ＞ 0.05).Conclusion FHR provides better results over PFNA regarding off-bed time,complication incidence and hip function,and hence is preferred for the treatment of elderly patients with intertrochanteric fractures,especially in those with severe osteoporosis.
ABSTRACT
Objective To investigate the related risk factors of bone cement leakage after percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) of osteoporotic vertebral compression fracture.Methods A retrospective study was made on 108 patients (114 vertebrae) undergone PVP and PKP between January 2008 and June 2014.There were 32 patients with cement leakage and 76 patients without cement leakage.Between-group differences were analyzed in terms of gender,age,number of one-time treated vertebrae,anatomic dissection,surgical procedures (PKP or PVP),integrity of the posterior vertebral wall,puncture approaches (unilateral or bilateral),technical level of surgeons and bone cement volume.Results Bone cement leakage occurred in 36 vertebrae (with the proportion of 31.6％).Cement leakage was associated with number of one-time treated vertebrae,surgical procedures,fractured condition,and bone cement volume (P ＜ 0.05),but not with gender,age,anatomical site of injury,puncture approaches,and technical level of surgeons (P ＞ 0.05).Conclusions Bone cement leakage after PKP or PVP correlated with number of vertebrae with one-time therapy,surgical procedures,fractured condition,and volume of bone cement.A good master of technical procedures and indications and suitable injection of high viscosity bone cement can help reduce the incidence of cement leakage.