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Objective To investigate the clinical effect of early holistic treatment in elderly patients with intertrochanteric fracture.Methods From January 2017 to December 2017,84 elderly patients with intertrochanteric fracture received by orthopaedics department of Shaoxing Central Hospital were divided into two groups .The observation group (46 patients) received early holistic therapy ,and the control group (38 patients) received traditional orthopaedic trauma treatment .Two groups of patients were treated with proximal femoral anti -rotation intramedullary nail fixation , and the therapeutic effect was compared between the two groups .Results After12 months of follow -up,the scores of Harris(evaluation standard of total hip joint curative effect ) pain,mobility,deformity,function and total scores in the observation group were (39.13 ±2.66) points,(3.40 ±0.44) points,(3.30 ±0.38) points,(37.73 ± 2.44)points,(83.56 ±2.51) points,respectively,which were higher than those in the control group [(37.05 ± 2.95)points,(3.17 ±0.59)points,(3.09 ±0.52) points,(35.67 ±3.19) points,(78.98 ±3.37) points],there were statistically significant differences between the two groups ( pain:t=3.395,P=0.001;activity:t=2.044,P=0.044;deformity:t=2.135,P=0.035;function:t=3.352,P=0.001;total score:t=7.131,P=0.000).After 12 months of follow-up,the excellent and good rate of operation in the observation group was 84.78％,which was higher than 71.05％in the control group ,there difference was statistically significant between the two groups (χ2 =5.477,P=0.019).The clinical statistics showed that the time from injury to operation ,the time of ambulation and hospitalization in the observation group were (2.31 ±0.53) d,(3.53 ±0.69) d,(15.86 ±2.60) d,respectively, which were shorter than those in the control group [(3.45 ±1.02) d,(5.02 ±1.13) d,(19.73 ±3.12) d],the differences were statistically significant between the two groups (the time from injury to operation:t=6.585,P=0.000;the time of ambulation after operation:7.128,P=0.000;hospitalization time:t =6.202,P=0.000).The incidence of complication was 6.52％in the observation group and 23.68％ in the control group,the difference was statistically significant between the two groups (χ2 =11.484,P=0.000).There was no death in the observation group at 12 months after operation,and the mortality rate in the control group was 2.63％,the difference was no statistically significant between the two groups (χ2 =2.665,P =0.102).Conclusion The application of early holistic treatment concept in the treatment of elderly patients with intertrochanteric fracture can improve the therapeutic effect and shorten the rehabilitation process of the patients .
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Objective@#To investigate the clinical effect of early holistic treatment in elderly patients with intertrochanteric fracture.@*Methods@#From January 2017 to December 2017, 84 elderly patients with intertrochanteric fracture received by orthopaedics department of Shaoxing Central Hospital were divided into two groups.The observation group (46 patients) received early holistic therapy, and the control group (38 patients) received traditional orthopaedic trauma treatment.Two groups of patients were treated with proximal femoral anti-rotation intramedullary nail fixation, and the therapeutic effect was compared between the two groups.@*Results@#After 12 months of follow-up, the scores of Harris(evaluation standard of total hip joint curative effect) pain, mobility, deformity, function and total scores in the observation group were (39.13±2.66)points, (3.40±0.44)points, (3.30±0.38)points, (37.73±2.44)points, (83.56±2.51)points, respectively, which were higher than those in the control group[(37.05±2.95)points, (3.17±0.59)points, (3.09±0.52)points, (35.67±3.19)points, (78.98 ±3.37)points], there were statistically significant differences between the two groups (pain: t=3.395, P=0.001; activity: t=2.044, P=0.044; deformity: t=2.135, P=0.035; function: t=3.352, P=0.001; total score: t=7.131, P=0.000). After 12 months of follow-up, the excellent and good rate of operation in the observation group was 84.78%, which was higher than 71.05% in the control group, there difference was statistically significant between the two groups (χ2=5.477, P=0.019). The clinical statistics showed that the time from injury to operation, the time of ambulation and hospitalization in the observation group were (2.31±0.53) d, (3.53±0.69)d, (15.86±2.60)d, respectively, which were shorter than those in the control group[(3.45±1.02)d, (5.02±1.13)d, (19.73±3.12)d], the differences were statistically significant between the two groups (the time from injury to operation: t=6.585, P=0.000; the time of ambulation after operation: 7.128, P=0.000; hospitalization time: t=6.202, P=0.000). The incidence of complication was 6.52% in the observation group and 23.68% in the control group, the difference was statistically significant between the two groups (χ2=11.484, P=0.000). There was no death in the observation group at 12 months after operation, and the mortality rate in the control group was 2.63%, the difference was no statistically significant between the two groups (χ2=2.665, P=0.102).@*Conclusion@#The application of early holistic treatment concept in the treatment of elderly patients with intertrochanteric fracture can improve the therapeutic effect and shorten the rehabilitation process of the patients.
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Objective: To summarize the evolving concept in treatment of intertrochanteric fractures and the development of internal fixation devices. Methods: Related literature concerning the implant devices to treat intertrochanteric fractures was reviewed and analyzed in terms of the biomechanical characteristics, clinical application, and complications. Results: The treatment of intertrochanteric fractures has undergone an evolving concept from conservative treatment to surgical treatment. Surgery strategies include extramedullary fixation and intramedullary fixation. Intramedullary fixation has gradually become the main treatment of intertrochanteric fractures due to its minimally invasive and biomechanical advantages. However, the current intramedullary fixation system still can not reconstruct the medial cortical support of the proximal femur, which leads to some failures in the treatment of unstable fractures. Conclusion: The development of internal fixation of intertrochanteric fractures is based on the deep understanding and biomechanical theory of intertrochanteric fractures in clinical practice. In the future, the updated design of internal fixation devices will depend on the treatment principle of reconstruction of medial support and secondary stabilization of intertrochanteric fractures, and finally the purpose of improving success rate and reducing postoperative complications of intertrochanteric fracture will achieved.
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A consistent diagnosis and classification system is important to ensure a good understanding of the pathophysiology and ultimate treatment of a disorder. Insomnia is one of the more common complaints encountered in the outpatient setting. Despite the prevalence of insomnia, evaluation, treatment, and research has been hampered by a lack of a standard definition of insomnia. In recent years, there have been important advances in the definition and classification of insomnia. The ICSD-3 and DSM-5 sleep-wake disorder classifications have moved away from the causal attributions that were inherent in previous classifications. The aim is simply to acknowledge the bidirectional and interactive effects between sleep disorders and coexisting medical and psychiatric illnesses. When medical and psychiatric illnesses coexist with insomnia, diagnosis of both disorders allows the plan for the management of insomnia to address both issues and apply comprehensive treatment.
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Humans , Classification , Diagnosis , Outpatients , Prevalence , Sleep Initiation and Maintenance Disorders , Sleep Wake DisordersABSTRACT
[Objective]To discuss the factors affecting the healing of trochanteric fracture in the eldly and the way to avoid the medical misplay which may occur.[Method]1.The outcome of 100 trochanteric fracture in the eldly were reviewed in order to analyze the flaw in their treatment and the reasons for non-union.Case history before injuries were inspected and active measures were taken.Some patients with severe condition in cardiovascular or respiratory system were treated by special department.2.Early and concrete surgical intervention were taken.3.Early exercise were discouraged to avoid fracture diseases(eg.Osteoporosis,articular degeneration,muscular flappy).[Result]Totally 100 patients were followed up for 1～5 years(average,3.8 years).Two patients(2%) died and 78(78%) regained normal living activities,12(12%) partially regained normal activities and 6(6%) lost their ability to normal life.Totally 98 patients receiving complete follow up,68 healed within 8～10 months,22 patients' healing time were longer than 10 months(included 3 mal-union with chronic infection).Internal fixation complication occurred in 12 patients(8 looses,4 ruptures).[Conclusion]For trochanteric fracture in the eldly people,early operation in the context of effective control over the systemic disorders could decrease the incidence of post-traumatic complication.Active exercise after operation could effectively improve the fracture healing and patient's life quality.