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Objective: To summarize the evolving concept in treatment of intertrochanteric fractures and the development of internal fixation devices. Methods: Related literature concerning the implant devices to treat intertrochanteric fractures was reviewed and analyzed in terms of the biomechanical characteristics, clinical application, and complications. Results: The treatment of intertrochanteric fractures has undergone an evolving concept from conservative treatment to surgical treatment. Surgery strategies include extramedullary fixation and intramedullary fixation. Intramedullary fixation has gradually become the main treatment of intertrochanteric fractures due to its minimally invasive and biomechanical advantages. However, the current intramedullary fixation system still can not reconstruct the medial cortical support of the proximal femur, which leads to some failures in the treatment of unstable fractures. Conclusion: The development of internal fixation of intertrochanteric fractures is based on the deep understanding and biomechanical theory of intertrochanteric fractures in clinical practice. In the future, the updated design of internal fixation devices will depend on the treatment principle of reconstruction of medial support and secondary stabilization of intertrochanteric fractures, and finally the purpose of improving success rate and reducing postoperative complications of intertrochanteric fracture will achieved.
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OBJECTIVE:To evaluate the effects of clinical pharmacists'intervention on prophylactic use of antibiotics in re-moval of internal fixation device for fracture. METHODS:Totally 117 patients underwent removal of internal fixation device for fracture were selected from some on third grade class A hospital during Mar.-Jul. 2015 as pre-intervention group. Totally of 266 pa-tients underwent removal of internal fixation device for fracture were selected during Aug. 2015-May 2016 as post-intervention group. Clinical pharmacists performed interventions based on Rationality Evaluation Criteria for Prophylactic Use of Antibiotics in Removal of Internal Fixation Device for Fracture. The prophylactic use of antibiotics was compared between 2 groups before and af-ter intervention. RESULTS:No unreasonable single dose or additional drug during surgery was found before and after intervention. After intervention,utilization rate of antibiotics for prophylactic use,the proportion of patients receiving antibiotics without indica-tions,the proportion of medication duration more than 24 h decreased from 84.6%,71.8%,48.7% to 17.3%,9.8%,4.9%,re-spectively. Average antibiotics cost,the proportion of total drug cost in hospitalization cost,the proportion of antibiotics cost in to-tal drug cost were all decreased significantly compared to before intervention,with statistical significance(P0.05). CONCLUSIONS:Clinical pharmacists'interventions significantly reduce the utilization rate of antibiotics for pro-phylactic use in patients underwent removal of internal fixation device for fracture,improve drug use without indications and ratio-nality of prophylactic use of antibiotics. There still are problems,such as unreasonable medication timing,continuous use time of more than 24 h,etc. It is necessary to continuous follow-up intervention.
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Objective To summarize the clinical effect of transpedicular Dynesys dynamic fixation for treating degenerative lum-bar disease.Methods 34 cases of degenerative lumbar disease were treated by transpedicular Dynesys dynamic fixation and per-formed the retrospective analysis.The VAS score of lumbago was (6.01±0.98),the VAS score of skelalgia was (5.47±0.63), ODI was(64.47 ±2.06)%.The cranial intervertebral space height in the fixed segment was(12.01±1.08)mm,the intervertebral space height in the fixed segment was(11.47±1.13)mm;the caudal intervertebral space height in the fixed segment was(11.95± 1.06)mm;the intervertebral motion range of the cranial segment in the fixed segment was(8.11±1.21)°,the intervertebral motion range of the fixed segment was(8.47±1.63)°,the intervertebral motion range of the caudal segment in the fixed segment(7.86± 1.36)°.39 intervertebral spaces in 27 cases adopted the decompression combined with Dynesys fixation,the single intervertebral space in 7 cases was performed with Dynesys fixation alone.Results All patients smoothly pulled through the perioperative period. No complications of wound infection,leakage of cerebralspinal fluid and nerve inj ury occurred,wound infection,leakage of cerebro-spinal fluid and nerve injury.All patients were followed up for 25-45 months,averaged 31.2 months.The VAS score of lumbago at the last time of follow up was (1.85±1.03),the VAS score of skelalgia was(1.54±0.18),ODI was(11.42±1.51)%,the cranial intervertebral space height in the fixed segment was(11.85±0.93)mm,the intervertebral space height of the fixed segment was (11.34±1.02)mm,the caudal intervertebral space height in the fixed segment was(11.62±0.97)mm;the intervertebral space motion range of the cranial segment in the fixed segment was(8.85 ± 1.33)°,the intervertebral space motion range of thye fixed segment was(4.54±1.78)°,the intervertebral space motion range of the caudal segment in the fixed segment was(7.62±1.21)°. Conclusion Transpedicular Dynesys dynamic fixation for treating degenerative lumbar disease can confine and reserve the motion range of the fixed segment,lessen lumbago and skelalgia,improve the function of waist and leg and have no obvious influence on the adjacent segment,its short-term therapeutic effect is satisfactory,but long-term therapeutic effect needs the clinical observation of long time and large amount cases.