ABSTRACT
Objective To compare the clinical effects of improved posterolateral minimally invasive approach and traditional posterolateral approach combined with modular femoral head prosthesis in the treatment of femoral neck fractures in the elderly. Methods The study involved 70 patients with femoral neck fractures (26 males and 44 females; at age range of 67-95 years,mean 78.3 years) treated from October 2008 to June 2010.There were 62 patients with fresh femoral neck fractures and eight with old femoral neck fractures (2-4 months post-injury),all of whom were type Ⅲ or Ⅳ fractures according to the Garden' s classification.All surgeries were completed by the same operation group.The improved posterolateral minimally invasive approach group involved 32 patients including 12 males and 20 females and the traditional posterolateral approach group involved 38 patients including 14 males and 24 females.The two groups were compared in aspects of incision size,operative time,perioperative complications,prosthesis stability and hip functional recovery. Results All patients were followed up for an average of 16 weeks (range,12-18 weeks).The differences between the two groups were significant regarding the incision length,perioperative blood loss,and blood product transfusio amount (P ＜0.01 ),but insignificant in operative time ( P ＞ 0.05 ).All patients were able to take weight-bearing walk six weeks postoperatively.The two groups showed significant difference in the hip joint function by Chamley's criteria six weeks postoperatively ( P ＜ 0.05 ),but insignificant difference in the hip joint function by Harris' s criteria at the last follow-up ( P ＜ 0.05). Conclusion The modified posterolateral minimally invasive approach combined with modular femoral head prosthesis is a satisfactory method in treatment of femoral neck fractures in senile patients,for it can result in less intra-operative soft tissue damage and blood loss,as well as shorter rehabilitation time.
ABSTRACT
[Objective]To explore displacement and plantar pressure distribution of the forefoot before and after the plantar fascia and other plantar ligaments were sectioned.[Method]Seven fresh adult cadaveric feet were tested with the main plantar ligaments exposed,including the plantar fascia,spring ligament,short plantar ligament and long plantar ligament.The displacements of the metatarsals were recorded and calculated with digital speckle correlation measurement(DSCM),also F-scan insoles were put under the plantar aspect of the feet when the speciments were loaded to 700N vertically.The special shifts and plantar pressure data of the metatarsals was collected and stored before and after the main plantar ligaments were sectioned.[Result]The transverse movements of the metatarsals did not change significantly,the same as their vertical displacements except the first metatarsal after the plantar fascia was sectioned,while the peak pressure shifted laterally.When the four major plantar ligaments were all injured,all of the above changed significantly.[Conclusion]The plantar fasciotomy will not consequentially lead to collapse of the forefoot structure.But the redistribution of the plantar pressure and the compensation of other ligaments may result in later complication.