RESUMEN
Objective To compare the recessive and dominant blood loss and total blood loss during the perioperative period between proximal femoral nail antirotation(PFNA)and artificial femoral head replacement in the treatment of Evans Ⅲ,Ⅳ type femoral intertrochanteric fractures for providing clinical evidence on selection of operative methods. Methods A retrospective study was conducted to analyze 61 older hospitalized patients with Evans Ⅲ,Ⅳ type femoral intertrochanteric fractures in Jimo City Traditional Chinese Medical Hospital from January 2009 to September 2014.The PFNA was adopted in 33 cases and the artificial femoral head replacement in 28 cases.The dominant blood loss was recorded,and total blood loss and recessive blood loss in the two groups were calculated by Gross equation according to the dominant blood loss,body height,body weight and hematocrit of pre-and post-operation. Results The average dominant blood loss in the intraoperative period was much less in the PFNA fixation group(106.2 ± 53.8)ml than in the artificial femoral head replacement group(274.6 ± 80.3)ml(P<0.05).The average recessive blood loss in the perioperative period was much less in artificial femoral head replacement group(577.0 ± 52.2)ml than in PFNA group(821.8 ± 69.5)ml(P<0.001).The total blood loss during the perioperative period was not significantly different between proximal femoral nail antirotation(896.0 ± 227.5)ml and artificial femoral head replacement(908.6 ± 204)ml(P>0.05). Conclusions There is obvious difference in the dominant blood loss between PFNA and artificial femoral head replacement for treatment of Evans Ⅲ,Ⅳ type femoral intertrochanteric fractures in the elderly patients.The proper operative method should be chosen based on the general condition of the elderly and fracture types.
RESUMEN
BACKGROUND:Salvia miltiorrhiza bone-setting capsule is a traditional Chinese medicine for the treatment of fractures due to activating blood circulation to dissipate blood stasis, reducing sweling and pain. OBJECTIVE: To observe the effects of Salvia miltiorrhiza bone-setting capsule on the fracture healing in a rat model of closed femoral fractures. METHODS: Rats were randomly divided into salvia miltiorrhiza bone-setting capsule group, physiological saline group and normal group. In the salvia miltiorrhiza bone-setting capsule group and physiological saline group, rat models of closed femoral fractures were prepared, and then given physiological saline and salvia miltiorrhiza bone-setting capsule 2 pils by intragastric administration. In the normal group, rats were housed normaly. At 7, 14 and 28 days after fractures, hematoxylin-eosin staining conditions, serum osteocalcin, the expression of colagen type I, and the expression of protein and mRNA calus transforming growth factor-beta 1 were observed in the salvia miltiorrhiza bone-setting capsule group and physiological saline group. RESULTS AND CONCLUSION: (1) Hematoxylin-eosin staining demonstrated that at 7 days after fractures, no significant difference was found in pathological changes of femoral fracture in salvia miltiorrhiza bone-setting capsule group and physiological saline group. At 14 and 28 days after fractures, pathological repair was more obvious in the salvia miltiorrhiza bone-setting capsule group than in the physiological saline group. (2) At 3 and 7 days after fractures, serum osteocalcin and the expression of type I colagen were significantly increased in the salvia miltiorrhiza bone-setting capsule group and physiological saline group (P < 0.05), and the expression trend was consistent in both groups. The expression was always higher in the salvia miltiorrhiza bone-setting capsule group than in the physiological saline group, and significant differences were found at 14 and 28 days after fractures (P < 0.01). (3) Transforming growth factor beta 1 expression reached a peak at 3 days after fractures, gradualy reduced, increased at 14 days (the second peak), and diminished at 28 days in the salvia miltiorrhiza bone-setting capsule group and physiological saline group. The expression trend of transforming growth factor beta 1 was consistent in the salvia miltiorrhiza bone-setting capsule group and physiological saline group. At 7, 14 and 28 days, the transforming growth factor beta 1 expression was higher in the salvia miltiorrhiza bone-setting capsule group than in the physiological saline group. (4) Results showed that salvia miltiorrhiza bone-setting capsule could promote fracture healing, and its mechanism was probably associated with serum osteocalcin, the expression of colagen type I and transforming growth factor-β1.