Résumé
Objective To study the mechanics situation of proximal femoral locking plate internal fixation after dynamic hip fixation in-tertrochanteric fracture. Methods Totally 10 couple of elderly proximal femur specimens were collected and intertrochanteric fracture model were prepared. Fixation material was removed after dynamic hip screw fixation. The left sides were collected as control group and given anti-rotation intramedullary nail internal fixation, while the right side were collected as observation group and given proximal femoral locking plate internal fixation. Then vertical displacement, axial stiffness and rotational stiffness under different loads were compared. Results Under dif-ferent loads, femoral bone vertical displacement and femur tuberosity vertical displacement in the observation group were both significantly shorter than those in the control group (P<0. 05), and femoral bone and femur tuberosity axial stiffness and rotational stiffness in the observation group were significantly higher than those of the control group (P<0. 05). Conclusion Proximal femoral locking plate internal fixation can improve stress load and enhance axial stiffness and rotational stiffness, and it's an ideal material for refracture fixation model after dynamic hip fixation intertrochanteric fracture.
Résumé
BACKGROUND:The effect of proximal femoral anti-rotation nail fixation in repair of intertrochanteric fracture is better than the other fixation materials. Unarmed inserting guided needle plays an important role for the quality of intertrochanteric fracture fixation. At present, there have been short of fast and accurate methods for inserting femoral canal guided needle from trochanter. OBJECTIVE:To investigate the operating skil s and application value of unarmed inserting guided needle in the process of proximal femoral anti-rotation nail Ⅱ fixation in repair of intertrochanteric fracture. METHODS:Standard operating procedures of guided needle inserting were established. The location of the guided needle was correct or was not judged through discriminating the feeling of inserting into the tip of femoral canal guided needle from trochanter. Slight resistance prompted that guided needle was in correct position. The guided needle closed to the medial femoral cortex and moved downward in the medul ary cavity. The guided needle was confirmed in the correct position by the perspective of C-arm in positive side position. This process was just one lateral perspective. Smoothly without resistance prompted that if the guided needle was out of the medul ary cavity, the direction of the inserting needle needed to be changed, without perspective. The resistance would be large if the needle tip piercing the medial femoral cortical bone, at this moment, the direction of the needle needed to be adjusted;or was blocked by malreduction of fracture or the free fracture block off the medul ary cavity;at this moment, fracture ends needed to be further restored. The surgery time, the time required to complete the guided needle inserting, the amount of bleeding, weight-bearing ambulation time and complications of 19 patients with intertrochanteric fracture treated by proximal femoral anti-rotation nail Ⅱ fixation were statistical y analyzed. RESULTS AND CONCLUSION:The average completed time for internal fixation was 45 minutes, the average desired time for guided needle inserting was 80 seconds, the average blood loss was 100 mL. There was no wound infection, or pressure sore formation. The shimoji time was an average of six weeks after treatment. Al patients were fol owed up for 4-9 months. Three patients needed crutches to walk before treatment, and after three months of treatment, they returned to the pre-exercise levels of injury. These results suggest that the procedure of unarmed inserting the guided needle provides guidance for the quick and correct completion of needle inserting, so as to enhance the internal fixation quality of proximal femoral anti-rotation nail Ⅱ in repair of intertrochanteric fracture, with a high reliability. It can significantly reduce the number of perspective, shorten surgery time, reduce the amount of bleeding and reduce complications.
Résumé
Clavicular crook plate is designed based on anatomic features of acromioclavicular joint,which matches clavicle appearance,and well attaches the shaft.Not passing through the joint,the internal fixation exhibits many advantages,such as convenient usage,reliable fixation and micromovement of fixed acromioclavicular joint.So the patients could move the joint early and avoid osteoarthritis.Allogenous tendon has abundant sources,simple sampling process,and short repairing duration and can reduce injury to patients.Cryopreserved allogenous tendon has low antigenicity and immunological refection,good histocompatibility.Reconstructed coracoclavicular ligament by allogenous tendon has good material intensity,and can meet the requirements of local stress,better substitute integrity and function of coracoclavicular ligament.Moreover,it has precise effect and simple operation.It acts as long-term fixator following plate removal,thus is important supplement of clavicular crook plate fixation.Clavicular crook plate fixation in combination with allogenous tendon transplantation reconstructs acromioclavicular joint stability,effectively provides early mechanical stability and subsequent biological stability,and maximizes restoration of acromioclavicular joint structure and function.