ABSTRACT
OBJECTIVE: The most commonly used intramedullary fixation systems for the treatment of elderly intertrochanteric fractures include the proximal femoral anti-rotation intramedullary nail (PFNA), the proximal femoral anti-rotation intramedullary nail of Asian (PFNA-II) and interlocking intramedullary nail for proximal femur (Inter-TAN), but the clinical effect of the three in the treatment of A2 and A3 type intertrochanteric fractures is still controversial. Meta-analysis was used to compare the clinical efficacy of Inter-TAN, PFNA, and PFNA-II in the treatment of unstable intertrochanteric fractures in the elderly. METHODS: A computer was used to search databases such as Cochrane, Embase, PubMed, Sinomed, CNKI, Wanfang, and VIP to collect and compare the literatures of Inter-TAN, PFNA, and PFNA-II in the treatment of elderly unstable intertrochanteric fractures. The search period was from the establishment of the database to December 2019. Two reviewers independently read the screening literature, extracted data and evaluated the quality. Meta-analysis was performed using RevMan5.3 software. RESULTS: (1) A total of eight studies were included, with 1 349 patients, including two randomized controlled studies and six cohort studies. The evidence level was ≥ III. (2) Meta-analysis showed that the operation time and intraoperative fluoroscopy time were longer, and intraoperative blood loss was more in the Inter-TAN group than those of the PFNA-II group [MD=-16.60, 95%CI (-23.22,-9.99), P 0.05). There was no significant difference in tip-apex distance, length of hospital stay, and Harris score of Inter-TAN group compared with PFNA group and PFNA-II group (P > 0.05). The incidence of postoperative screw cut-out in the Inter-TAN group was less than in the PFNA group and the PFNA-II group [OR=6.47, 95%CI(2.79, 15.00), P 0.05). CONCLUSION: For patients with osteoporosis and poor stability, Inter-TAN can provide better stability and reduce postoperative complications. For patients with poor general conditions and greater surgical risk, PFNA-II internal fixation can be selected.
ABSTRACT
Objective To explore the initial effects of the treatment of proximal femoral nail-helical blade (PFNA) in elderly patients with intertrochanteric fracture of the incomplete lateral wall type. Methods A total of 25 patients were enrolled in this study including 8 cases of type A2, 17 cases of type A3 according to AO classification. All patients under-went three-dimensional CT scan. In all patients with type A2 fracture, there were 6 cases with coronal plane fracture on the greater trochanter, and PFNA was used instead of DHS when an iatrogenic fracture occurred in 2 patients. All other patients were treated with closed reduction and fixed with PFNA. Results All patients healed and the average healing time was 11 weeks, one patient fell down once again and the fracture occurred on the shaft, when a long PFNA was used, both of the frac-tures healed 14 weeks after surgery. In all of the 25 patients,1 patient died due to cerebral hemorrhage 13 months after sur-gery;2 patients needed walking aids due to the presence of osteoarthritis of the knee and calf muscular venous thrombosis was diagnosed in 3 cases. No complications were found in the other patients, such as infection, nonunion and fixation failure. According to the Harris hip score system, there were 14 cases of“excellent”,8 cases of“good”,2 cases of“fair”and1 pa-tient of“poor”.Conclusion The PFNA treatment can provide a good fixation for intertrochanteric fractures of incomplete lateral wall type, which allow patients to do exercise early and achieve an excellent initial outcome.
ABSTRACT
The ischemic preconditioning was initially identified as a protective maneuver induced by brief periods of ischemia followed by reperfusion. Although ischemic preconditioning can reduce ischemic injury of heart, skeletal muscle and neuronal tissue, it's protective mechanism remains elusive. Recently, several investigations suggest the associations of nitric oxide with protection from ischemic injury. Nitric oxide synthesized by a member of nitric oxide synthase (NOS) family has been known to increase or decrease the ischemic injury. The purpose of this study was to observe the expression patterns of NOS 1, NOS 2 and NOS 3 in the rat skeletal muscle after cyclic episodes of short ischemia and reperfusion. Nine and thirty-five weeks-old male Sprague-Dawley rats were divided into control and cyclic short ischemia and reperfusion groups. The experimental group was further divided into 3 groups based on cycles of short ischemia and reperfusion. For cyclic short ischemia and reperfusion, left commom iliac artery was occluded 3, 6 and 10 times for 5 minutes ischemia followed by 5 minutes reperfusion using rodent vascular clamps. The animals were sacrificed at hours 0, 3, 6, 24 and 72 after reperfusion and the left rectus femoris muscles were removed. The expression profiles and distribution of NOS 1, NOS 2 and NOS 3 were examined with immunohistochemical staining. The results were as follows; In the cyclic of short ischemia and reperfusion groups, the mortality was increased with increasing of cyclic episodes at 72 hours after reperfusion, and aging. In the control group, NOS 1, NOS 2 and NOS 3 immunoreactivities showed no differenes with aging. In the 9 weeks-old rats, NOS 1 immunoreactivities were observed moderate at 24 hours after 6 times of short ischemia and reperfusion, and moderate and strong at 24 hours after 10 times of short ischemia and reperfusion. In the 35 weeks-old rats, NOS 1 immunoreactivities were observed trace or mild at 24 hours after 6 and 10 times of short ischemia and reperfusion. At 3 hours after 3 times of short ischemia and reperfusion, NOS 2 immunoreactivities were observed moderate or strong, and trace in the 9 and 35 weeks-old rats, respectively. At 3 hours after 10 times of short ischemia and reperfusion, NOS 3 immunoreactivities were observed mild or moderate, and trace or negative in the 9 and 35 weeks-old rats, respectively. In summary, the expression profile of NOS 1, NOS 2 and NOS 3 were observed differently with increasing episodes of short ischemia and reperfusion. The alteration was the most prominent in NOS 3 than in NOS 1 and NOS 2. These results suggest that the alteration of NOS 3 known to protect tissue against ischemic injury may be associated with increasing mortality after multiple episodes of short ischemia and reperfusion.