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Objective:To investigate the changes of perioperative serum osteosclerosis protein (SOST) and Dickkopf-3 (Dkk-3) in elderly patients with femoral intertrochanteric fracture.Methods:Thirty elderly patients who underwent reduction and fixation of femoral intertrochanteric fracture in Baoding Second Hospital from May 2017 to December 2017 were prospectively selected as the observation group; 30 healthy subjects in the same period were selected as the healthy control group. Enzyme linked immunosorbent assay (ELISA) was used to detect the expression of serum SOST and Dkk-3 at 1 d before operation and at 1, 3, 5 d after operation and compared with the same period of healthy physical examination(normal control group). Spearman rank correlation analysis was used to analyze the correlation between SOST and Dkk-3 and disease activity score (ASDAS) and spinal imaging evaluation score (mSASSS).Results:There was a positive correlation between Dkk-3 level and ASDAS score in the observation group ( r = 0.331, P = 0.012); the level of SOST was negatively correlated with the scores of ASDAS ( r = - 0.162, P = 0.017). The levels of serum SOST and Dkk-3 in the observation group were lower than those in the healthy control group: 1.29(1.00, 2.40) μg/L vs. 1.96(1.63, 2.65) μg/L, (6.11 ± 1.15) μg/L vs. (9.81 ± 1.76) μg/L, P<0.05. The levels of serum SOST and Dkk-3 in the observation group increased first and then decreased on the 1st, 3rd and 5th day after operation. The level of serum Dkk-3 increased to the highest level on the 3rd day after operation, and then decreased gradually, but it was still slightly higher than that before operation. The level of serum SOST in the observation group increased to the highest level 1st day after operation, and decreased at 3rd and 5th day after operation. The perioperative serum levels of SOST and Dkk-3 in the observation group were positively correlated, the correlation coefficient was the largest at 1 day after operation ( r = 0.571) and the lowest before operation ( r = 0.119). Conclusions:The perioperative serum levels of SOST and Dkk-3 in elderly patients with femoral intertrochanteric fracture increased first and then decreased. The change of serum SOST level is more sensitive and can be used as a sensitive index to reflect the change of osteogenic ability.
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Objective:To study the clinical application of hanging moxibustion in intervention of deep venous thrombosis (DVT) of lower extremity after intertrochanteric fracture of femur, in order to provide theoretical basis for the clinical application of suspension moxibustion.Methods:By adopting a controlled clinical trial method, a total of 100 patients with femoral intertrochanteric fracture who came to Keqiao District Hospital of Traditional Chinese Medicine, Shaoxing City, Zhejiang Province for orthopaedic surgery from January 2021 to September 2022 were selected by convenient sampling method and randomly divided into the control group and the observation group, 50 cases in each group. The control group was given routine nursing intervention, and the observation group was given the traditional Chinese medicine nursing intervention of hanging moxibustion on the basis of the control group. The changes of coagulation function indexes, hemorheology indexes, hemodynamics, the swelling degree score of the affected limb, and the Visual Analogue Scale (VAS) of the affected limb pain in the two groups of patients with intertrochanteric fracture before and 14 days after the intervention, and the incidence of lower extremity deep venous thrombosis (DVT) in the two groups after 1 d, 3 d, 7 d, and 14 d of intervention were observed and recorded.Results:After 14 days of intervention, D-dimer, fibrinogen and prothrombin time in the observation group were (380.64 ± 41.78) μg/L, (4.51 ± 0.49) g/L and (10.46 ± 1.04) s, respectively, which were better than those in the control group (464.91 ± 46.81) μg/L, (4.82 ± 0.56) g/L and (12.85 ± 1.12) s with statistical difference ( t=9.50, 2.95, 11.06, all P<0.05). After 14 days of intervention, the whole blood low tangential viscosity, whole blood high tangential viscosity and plasma viscosity in the observation group were (8.34 ± 0.42), (3.72 ± 0.28) and (1.21 ± 0.18) mPa/s, respectively, which were significantly lower than (8.90 ± 0.46), (4.13 ± 0.26) and (1.53 ± 0.22) mPa/s in the control group ( t=6.36, 7.59, 7.96, all P<0.05). After 14 days of intervention, the postoperative blood flow, maximum blood flow velocity and average blood flow velocity in the observation group were (1.89 ± 0.26) L/min, (31.57 ± 3.29) cm/s, (34.41 ± 3.62) cm/s, which were significantly higher than (1.45 ± 0.21) L/min, (24.18 ± 2.85) cm/s, (27.96 ± 3.15) cm/s in the control group ( t=9.31, 12.01, 9.50, all P<0.05). After 14 days of intervention, the total incidence of lower limb DVT in the observation group was 2.00%(1/50) , lower than 24.00%(12/50) in the control group, the difference between the two groups was significant ( χ2=10.70, P<0.05). Conclusions:Suspended moxibustion can significantly improve the coagulation function, hemorheology, hemodynamics, swelling and pain of the affected limb in patients with postoperative intertrochanteric fracture of the femur, and reduce the occurrence of DVT in the lower extremity. It is recommended to be widely used in clinical practice.
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Objective: To compare the effectiveness of proximal femoral nail anti-rotation (PFNA) in the treatment of intertrochanteric fracture of femur in traction bed supine position and non-traction bed lateral position. Methods: A retrospective analysis of 102 elderly patients with intertrochanteric fracture of femur who met the selection criteria between January 2013 and April 2018 was made. According to the different operative positions, the patients were divided into two groups: group A (50 cases, PFNA internal fixation in traction bed supine position) and group B (52 cases, PFNA internal fixation in non-traction bed lateral position). There was no significant difference in age, gender, fracture side, cause of injury, AO classification, complications, and time from injury to operation between the two groups ( P>0.05). The preoperative preparation time, incision length, operation time, intraoperative blood loss, intraoperative X-ray fluoroscopy times, fracture healing time, and complications were recorded and compared between the two groups, and the effectiveness was evaluated by Harris hip score at 1 year after operation. Results: There was no significant difference in incision length between groups A and B ( t=1.116, P=0.268). In addition, the preoperative preparation time, operation time, intraoperative blood loss, and intraoperative X-ray fluoroscopy times in group A were significantly greater than those in group B ( P<0.05). Both groups were followed up 12-14 months, with an average of 13 months. There were 3 postoperative complications in group A and group B respectively. In group A, there were 2 cases of hip joint pain and 1 case of local fat liquefaction (healed after dressing change); in group B, there were 2 cases of hip joint pain and 1 case of deep vein thrombosis in lower extremity; there was no significant difference in the incidence of postoperative complications between the two groups ( P=0.642). The patients of the two groups had a good result of fracture reduction and the internal fixation quality, and there was no main nail loosening, screw fracture, spiral blade cutting, withdrawal, and the nail breakage occurred, and no nonunion of bone, coxa vara, and other complications occurred. X-ray showed that the fracture healed in both groups, and there was no significant difference in fracture healing time between the two groups ( t=1.515, P=0.133). There was no significant difference in Harris hip score between the two groups at 1 year after operation ( t=0.778, P=0.438). Conclusion: Compared with the traction bed supine position, PFNA internal fixation for intertrochanteric fracture of femur in the non-traction bed lateral position has the advantages of short preparation time, short operation time, less intraoperative blood loss, less X-ray fluoroscopy times, and satisfactory postoperative recovery effect.
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Objective: To compare the effectiveness of proximal femoral nail anti-rotation (PFNA) combined with minimally invasive percutaneous plate osteosynthesis (MIPPO) and Intertan intramedullary nail fixation by closed reduction in the treatment of AO/Orthopaedic Trauma Association (AO/OTA) type 31-A3.3 intertrochanteric fracture with incomplete lateral wall. Methods: The clinical data of 54 patients with AO/OTA type 31-A3.3 intertrochanteric fracture who met the selection criteria and were admitted between January 2012 and January 2018 were retrospectively analyzed. According to different surgical methods, the patients were divided into group A (24 cases with lateral wall reconstruction by MIPPO combined with PFNA internal fixation) and group B (30 cases with Intertan intramedullary nail fixation by closed reduction only). There was no significant difference between the two groups ( P>0.05) in terms of gender, age, side of injury, cause of injury, and combined medical diseases. The operation time, intraoperative blood loss, time to weight-bearing, fracture healing time, and postoperative complications were recorded and compared between the two groups. The tip apex distance (TAD) was measured at 2 days, 2 months, and 1 year after operation. At 12 months after operation, the hip joint function was evaluated according to Harris scoring standard, and the rate of conformity (Harris score were more than 70) was calculated. Results: The wounds of the two groups healed by first intention, without infection, skin deformity, and other incision complications. The operation time and intraoperative blood loss of group A were significantly more than those of group B, and the time to weight-bearing and fracture healing were significantly shorter than those of group B ( P0.05). There was 1 case of infection, 1 case of screw withdrawal, 2 cases of screw removal, and 1 case of bone nonunion in group B, the incidence of complications was 16.7%; there was only 1 case of screw withdrawal combined with screw blade withdrawal in group A, the incidence of complications was 4.2%; there was no significant difference between the two groups ( χ2=2.109, P=0.146). At 12 months after operation, the Harris scores of pain, function, malunion, range of motion, and total score in group A were significantly better than those in group B ( P<0.05). The rate of conformity of group A was 95.83% (23/24) and 76.67% (23/30) in group B, and the difference between the two groups was significant ( χ2=3.881, P=0.049). Conclusion: For the AO/OTA type 31-A3.3 intertrochanteric fracture with incomplete lateral wall, compared with the closed reduction Intertan intramedullary nail fixation, the incidence of internal fixation failure after MIPPO reconstruction with lateral wall combined with PFNA fixation was lower, the time to weight-bearing was earlier, and the postoperative function was better.
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Objective In clinic, the elderly with femoral intertrochanteric fracture are suggested surgical treatment, with the continuous deepening of the research and technology innovation, the new type of internal fixator for treating this fracture are emerging?At present,a wide variety of internal fixators in clinic,but each has its advantages, disadvantages and indications, and considering?The right choice of internal fixator directly affects patient's prognosis?This article reviewed several common internal fixators in clinic, so as to provide a reference for the clinical selection.
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PURPOSE: The purpose of this study was to evaluate the usefulness of bipolar hemiarthroplasty using a cementless femoral stem for treating unstable intertrochanteric fractures in elderly patients. MATERIALS AND METHODS: This study included 41 hips of 41 patients who were followed up for over 2 years after bipolar hemiarthroplasty using cementless femoral stem between October 2006 and November 2008. The mean follow-up period was 33 months (24-42 months). RESULTS: At the last follow-up, the mean Harris hip score was 81.3 points. All stems were stable without significant changes in alignment or progressive subsidence. There were no cases of leg length discrepancy over 5 mm. There were 3 cases of wire fixation breakage and 1 case of posterior hip dislocation. CONCLUSION: The short-term results over 2 years of clinical and radiological evaluation of cementless bipolar hemiarthroplasty and wire fixation were satisfactory in elderly patients with unstable intertrochanteric fracture.
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Aged , Humans , Follow-Up Studies , Hemiarthroplasty , Hip , Hip Fractures , LegABSTRACT
Kyphoscoliosis is a deformity of the costovertebral skeletal structures characterized by an anterior flexion (kyphosis) and lateral curvature (scoliosis) of the patient's vertebral column.(1)) In kyphoscoliosis, lung volume and compliance is reduced due to the change of vertebral column. The work of breathing is increased by abnormal mechanism of the thorax and by increased airway resistance resulting from small lung volume. Airway management and respiratory problems are common and spinal deformities can cause difficulties with regional anesthesia. We had experienced a successful spinal anesthesia for closed reduction and internal fixation (CRIF) and proximal femoral nail (PFN) of fractured intertrochanteric femur in a patient with extremely severe thoracolumbar kyphoscoliosis.
Subject(s)
Humans , Airway Management , Airway Resistance , Anesthesia , Anesthesia, Conduction , Anesthesia, Spinal , Compliance , Congenital Abnormalities , Femur , Kyphosis , Lung , Nails , Scoliosis , Spine , Thorax , Work of BreathingABSTRACT
Objective To compare the clinical results of the intramedullary nails (Gamma nail and the proximal femoral nail) in treatment of intertrochanteric fractures of femur. Methods A review study was conducted on 116 intertrochanteric fractures of femur treated with the Gamma nail and 89 treated with PFN in our hospital between 2000 and 2003. Results In the Gamma nail group, the mean time for operation was 68.3(48 to 106)minutes,the mean blood loss during operation was 261(180 to 400)mL,the mean time for walking after operation was 5.0 (2.3 to 8.9)weeks and the mean time for bone union was 8.6(7.1 to 12.6)weeks. In the PFN group, the mean time for operation was 48.0(36 to 85)minutes, the mean blood loss during operation was 192(120 to 360)mL,the mean time for walking after operation was 5.3(2.5 to 8.1)weeks and the mean time for bone union was 8.8(6.9 to 12.1)weeks. There were significant differences in the mean time for operation and the mean blood loss between the 2 groups(P
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Objective To study of long-stem proshetic replacement of comminuted intertrochanteric fracture of femur in the elderly patients. Method Fifteen consecutive patiens who were more than 70 years old and had an unstable intertrochanteric fracture were treated with long-stem proshetic replacement from 2001 to 2003.The average hospital stay ,the average time to amblulation with full-weith bearing on the operated limb after operation and complication were observed. Result The average hospital stay of the patiens was 16 days,,the average time to amblulation was 14 days , the pain of the hip was two cases. Conclusion Long-stem proshetic replacement of comminuted intertrochanteric fracture of femur in the elderly pateins may be a suitable alternative to internal fixation because the prothesis provides for early full weigh-bearing and rapid rehabilitation.
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Intertrochanteric fracture of femur is increasing in their incidence. Recently Ender nail and compression hip screw are very popular but they have disadvantage in the treatment of intertrochanteric fracture of femur. We have treated 49 cases of intertrochanteric fractures from December 1979 to October 1985 using Ender nail(31 cases) and compression hip screw(18 cases) respectively and compared the results. The summary of the results obtained were as follows: l. Average operation time was 72 minutes in Ender nail group and 146 minutes in compression hip screw group. 2. Average blood loss was 154ml in Ender nail group and 661ml in compression hip screw group. 3. Roentgenographic union was obtained in 12 weeks in both groups. 4. Minor postoperative complications were 24 cases in Ender nail group and 3 in compression hip screw group. Among 24 complications of Ender nail group, 19 were about the knee joint. Our conclusion is that Ender nailing is useful modality in the treatment of unstableintertrochanteric fractures who are old and high risk patients.