ABSTRACT
Objective To investigate the causes and managements of postoperative complications of proximal femoral nail anti-rotation(PFNA)in treating intertrochanteric fractures. Methods A total of 155 patients with intertrochanteric fractures were treated with PFNA from January 2011 to December 2017.Causes and managements of postoperative complications were analyzed and discussed. Results At an average follow-up of 48 months(range ,12~72 months) ,the rate of good postoperative recovery in hip function was 96.0% . Among 155 patients ,the internal fixation-associated postoperative complications occurred in 15(9.7% )patients.Details were as follows :7 cases had spiral blade breakage into the femoral head or inwardly ,in whom 5 cases received artificial joint replacement whereafter.5 cases had coxa vara ,mainly in patients with obvious posterior fracture of the femoral intertrochanter with obviously bone fragments.3 cases had delayed fracture healing due to the fracture damaging calcar femorale ,or extensive soft tissue dissection during the operation on small trochanter. The Harris function score was 82 points. Conclusions The location of the PFNA spiral blade ,as an important factor ,is correlated with postoperative complications ,while severe osteoporosis ,unstable fractures ,and poor fracture reduction increase the incidence of surgical complications.
ABSTRACT
Objective To discuss the clinical application of mechanical thrombectomy with AngioJet system for acute lower limb arterial ischemia (ALI).Methods A total of 12 ALI patients,who underwent percutaneous mechanical thrombectomy with AngioJet systemn during the period from January 2015 to November 2016,were enrolled in this study.The clinical data were retrospectively analyzed.The blood flow classification score after thrombolysis in myocardial infarction (TIMI) was used to evaluate the blood perfusion condition,and Cooley standard of efficacy score was used to assess the clinical curative effect.Results The technical success rate of mechanical thrombectomy with AngioJet system was 91.7％ (11/12).The average restored perfusion time was (1.5±0.6) hours.The clinical success rate and limb salvage rate were 83.3％ (10/ 12) and 91.7％ (11/12),respectively.The TIMI flow scores were improved from preoperative grade 0 (n=8) and Ⅰ (n=4) to postoperative grade 0 (n=1),Ⅰ (n=3) and Ⅱ (n=8).In 11 patients (91.7％) the symptoms of lower limb arterial ischemia were strikingly improved after mechanical thrombectomy.In one patient,the postoperative TIMI flow score remained 0 as preoperative state and the symptoms of lower limb arterial ischemia were not improved although catheter directed thrombolysis therapy was employed for 24 hours,and above-knee surgical amputation had to be carried out.Cooley efficacy score showed that complete cure was seen in 4 patients (33.3％),good response in 6 patients (50.0％),general improvement in one patient (8.3％) and pool response in one patient (8.3％).No severe bleeding complications occurred.Conclusion Percutaneous mechanical thrombectomy with AngioJet can rapidly recover the blood perfusion in patients with ALI,thus,further deterioration of the disease can be prevented and the limb salvage rate can be improved.Therefore,this technique has good clinical application value.