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BACKGROUND: Osteoporosis and fracture type are two important reasons for the failure of internal fixation of proximal femoral nail antirotation. Type AO31-A3.3 intertrochanteric fracture, because of its involvement in the lateral wall, greatly increased the instability of the fracture. In addition, the elderly are mostly osteoporosis patients, so failure and postoperative complications of internal fixation of proximal femoral nail antirotation in the elderly with type AO31-A3.3 intertrochanteric fracture are higher. OBJECTIVE: To explore the difference of biomechanics between bone cement augmented and common proximal femoral nail antirotation in the treatment of type AO31-A3.3 intertrochanteric fracture. METHODS: CT data of one 75-year-old volunteer with intertrochanteric fracture were selected to import into Mimics 19.0 and Geomagic studio 2017 software to extract and optimize the three-dimensional model of the right femur. SolidWorks 2017 software was used to draw the internal fixation model and assemble it with the femur model according to the standard operation technology. The model was imported into Hypermesh 14.0 software to cut the bone to obtain the type AO31-A3.3 model with common proximal femoral nail antirotation. The cancellous bone around the proximal end of the screw blade was redefined as bone cement, which is the model of bone cement augmented proximal femoral nail antirotation. The material property parameters, boundary conditions and applied loads were set up and stored as K files respectively and imported into LS-DYNA software for solution. RESULTS AND CONCLUSION: (1) Compared with the common proximal femoral nail antirotation, the treatment of the elderly type AO31-A3.3 intertrochanteric fracture with the bone cement augmented proximal femoral nail antirotation has the advantages of lighter cutting degree of the screw blade, smaller varus, rotation angle and displacement of the femoral head and neck bone block, and better biomechanical effect. (2) The complete lateral wall can effectively support the femoral head and neck bone block and resist the skull and neck bone block as the lateral action point of three-point support. The pronation and rotation tendency can effectively prevent the head and neck screws from withdrawing. (3) The strong anchoring force of bone cement can stabilize the screw blade, enhance the internal action point of three-point support, and conduct and disperse the pressure.
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Objective To investigate the clinical effect of bipolar artificial femoral head replacement in the treatment of elderly patients with unstable intertrochanteric fractures. Methods 82 elderly patients with unstable intertrochanteric fractures were randomly divided into two groups with 41 cases in each group. The control group was treated with dynamic hip screw internal fixation, and the observation group was treated with bipolar artificial femoral head replacement. The operation time, bleeding volume and ambulation time were compared, and all the patients were followed up for one year. Harris scores of the two groups at 1 month, 3 months, 6 months, and 12 months after operation were compared, and the incidence of complications were recorded and compared. Results The operation time, bleeding volume and ambu-lation time of the observation group were less than the control group with a statistically significant difference (P0. 05). The incidence of complication of the observation group was lower than that of the control group, the difference was statistically significant (P<0. 05). Conclusion Bipolar femoral head replacement has the advantages of simple operation, less trauma and complications. It is conducive to the early ambulation of patients and the recovery of hip function, and it is suitable for elder-ly patients with unstable femoral intertrochanteric fracture.
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PURPOSE: To evaluate the efficacy of mini-incision reduction technique in unstable intertrochanteric femoral fracture treated with intramedullary nail. MATERIALS AND METHODS: From January, 2005 to December, 2007, we selected 26 patients of unstable intertrochanteric femoral fracture which underwent anatomic reduction by mini-incision reduction technique using various instruments, and treated with intramedullary nail. We evaluated the radiological results with the union time, change of femoral neck-shaft angle and distance of lag screw sliding by follow-up radiography, and the clinical results with the mobility score of Parker and Palmer, Salvati and Wilson hip function scoring system and Jensen index. RESULTS: The mean union time was 18.9 weeks. The mean changes of femoral neck-shaft angle was 4.1 degree. The mean distance of lag screw sliding was 4.4 mm. Decrease of mobility score of Parker and Palmer, Salvati and Wilson hip function score was showed, and social function score of Jensen maintained 54% compared with preoperative score. CONCLUSION: Mini-incision reduction technique using various instruments showed satisfactory clinical and radiological results, and we believe that it is a recommendable method in unstable intertrochanteric femoral fracture which manual reduction is difficult.
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Humanos , Fraturas do Fêmur , Seguimentos , Quadril , UnhasRESUMO
Objective To evaluate the therapeutic effect of proximal femoral nail(PFN)and dynamic hip screw(DHS)for intertrochanteric femoral fracture(IFF).Methods From September,2004 to May,2007,39 IFF patients treated by PFN and 36 by DHS were enrolled into the analysis.The operative complications,postoperative complications and the recovery of hip function of IFF patients were observed to evaluate the therapeutic effect of the two methods.Results The blood loss amount was higher,the incidence of postoperative complications was higher and the excellent rate of Harris score of hip function was lower in IFF patients treated by DHS than that in IFF patients by PFN(P