RESUMO
Objective To compare the function recovery of multiple injuries combined with floating knee joint injury and simple knee joint injury,and to analyze the risk factors.Methods A retrospective case control study was conducted to analyze the clinical data of 41 patients with multiple injuries combined with Blake and McBryde Ⅱ A floating knee injury admitted to Xijing Hospital of Air Force Medical University from June 2011 to June 2017.There were 26 males and 15 females,aged 18-76 years,with an average of 34.5 years.There were 25 patients with simple knee joint injury and and 16 patients with multi-joint combined injury involving knee joint and ipsilateral hip joint or ankle joint injury.Surgical fixation was performed in different parts by external fixation,intramedullary nail and plate screw fixation.According to the Kalstr(o)m and Olerud functional evaluation criteria,the excellent and good rate of postoperative functional recovery was compared between the two groups.The surgical fixation methods of the two groups were compared.Logistic regression analysis was performed on the influencing factors of functional recovery.Results The patients were followed up for 1-7 years,with an average of 3 years.The excellent and good rate of overall functional recovery in the two groups was 68％,and the rate was 84％ in simple knee injury group and 44％ in multi-joint combined injury group (P ＜ 0.01).There was no significant difference in the ratio of intramedullary nail and plate screw fixation between the two groups (P ＞ 0.05),while the proportion of the external fixation in the multi-joint combined injury group [31％ (5/16)] was significantly higher than that in the simple knee joint injury group [16％ (4/25)] (P ＜ 0.05).Logistic regression analysis showed that the rate of external fixation was an independent factor affecting the postoperative function (OR =0.15,P ＜ 0.01).Conclusions The postoperative function in multi-joint injury patients is poorer than in the single joint injury patients.The higher rate of using external fixation in multi-joint injury patients is a risk factor.For Blake and McBryde Ⅱ A floating knee injury combined with multi-joint injury,less external fixation should be used,so as to improve the postoperative function.
RESUMO
Objective To investigate the clinical effect of Gamma 3 intramedullary nails for the treatment of unstable intertrochanteric fractures in the elderly. Methods A total of 36 elderly patients (aged over 70 years)with unstable intertrochanteric fractures (Evans type Ⅲ or above)treated with Gamma 3 intramedullary nails from January 2013 to December 2016 were followed up and analyzed. Results All patients were followed up for 6 to 12 months ,with an average of (9.4 ± 2.6) months. The fractures were healed in all patients ,and the healing time was between 10 and 18 weeks , with an average of 14 weeks. A mild type of coxa varus was found in 2 cases. According to the Harris hip score ,the curative effect was excellent in 24 cases ,good in 7 cases ,fair in 3 cases and poor in 2 cases. The excellent and good rate was 86.1% . Conclusions The gamma 3 intramedullary nail is an outstanding internal fixation tool for the treatment of unstable intertrochanteric fractures in the elderly ,with such advantages as minimal trauma ,short operation time ,firm fixation and few postoperative complications.