[Comparison of clinical effects of minimally invasive femoral head replacement and proximal femoral nail antirotation in the treatment of comminuted intertrochanteric fracture in the elderly].

OBJECTIVE: To analyze the clinical effect of minimally invasive femoral head replacement and proximal femoral nail antirotation(PFNA) internal fixation at the same time in the treatment of elderly patients with comminuted intertrochanteric fracture. METHODS: From April 2020 to October 2020, 76 elderly patients with comminuted intertrochanteric fracture treated by minimally invasive femoral head replacement and PFNA were analyzed retrospectively. There were 35 patients in the prosthetic group, including 24 females and 11 males with an average age of (86.2±6.1) years old. There were 41 patients in PFNA group including 28 females and 13 males with an average age of (84.6±5.3) years old. The operation time, intraoperative blood loss, postoperative ambulation time, hospitalization time and complications were observed and compared between two groups. Harris hip score was performed at 1, 6 and 12 months after operation. RESULTS: All patients were followed up for 13 to 17 months with an average of (14.3±1.4) months. The operation time of the prosthesis group was longer than that of the PFNA group (P<0.05);the amount of bleeding in PFNA group was less than that in prosthesis group (P>0.05);the time of ambulation in prosthetic group was earlier than that in PFNA group(P<0.05);the number of complications in the prosthesis group was less than that in the PFNA group(P<0.05); the Harris score of prosthesis group was significantly higher than that of PFNA group at 1 and 6 months after operation (P<0.05), but there was no significant difference in Harris score between two groups at 12 months after operation(P>0.05);the number of complications in the prosthesis group was less than that in the PFNA group (P<0.05). CONCLUSION: Minimally invasive femoral head replacement is a good choice for the elderly patients with commuited intertrochanteric fracture. It can improve the quality of life and reduce the burden of family members and society.

[Comparison of clinical efficacy of femoral calcar prosthesis replacement and intramedullary nail in the treatment of elderly patients with intertrochanteric fracture].

OBJECTIVE: To analyze the clinical efficacy of hip arthroplasty with femoral calcar prosthesis and proximal femoral nail fixation(PFNA) in the treatment of elderly patients(≥80 years old) with unstable intertrochanteric fractures(Evans Ⅲ, Ⅳ). METHODS: From June 2016 to March 2018, 60 elderly patients with unstable intertrochanteric fractures treated with prosthetic replacement and PFNA were retrospectively analyzed. According to the surgical methods, they were divided into PFNA group and prosthesis group. In PFNA group there were including 21 males and 15 females, with an average age of(84.3± 2.9) years old;in the prosthetic group, there were 10 males and 14 females with an average age of (82.9±2.4) years old. The operation time, hemoglobin difference between preoperative and postoperative 1 day, postoperative ambulation time, hospitalization time and complications were observed and compared between the two groups. Harris hip score was performed 3 and 12 months after operation. RESULTS: All patients were followed up for 12 to 24 months (19.3±4.8) months. One patient in the prosthesis group died of lung cancer one year later and the follow-up was terminated. The operation time of prosthetic group was longer than that of PFNA group(P<0.05);hemoglobin difference before and after operation had no difference between prosthetic group and PFNA group(P>0.05);the time of ambulation in prosthetic group was earlier than that in PFNA group(P<0.05); the number of complications in prosthetic group was less than that in PFNA group(P<0.05);there was no significant difference in Harris score between prosthetic group and PFNA group before treatment, but scores of both groups were significantly increased after treatment (P <0.05). After 3 months of follow-up, the score of prosthesis group was higher than that of intramedullary nail group(P<0.05), but there was no significant difference at 12 months after operation(P>0.05). CONCLUSION: The elderly patients with intertrochanteric arthroplasty can reduce the burden of intertrochanteric arthroplasty and improve the quality of life.

[Biomechanical research of SOX9, CTGF in bone tendon junction healing].

AIM: To investigate the biomechanical effect of SOX9, CTGF in bone tendon junction healing. METHODS: 36 adult New Zealand rabbits were randomly divided into A, B and C groups(each group were 12 rab-bits). Group A with SOX9 inject into bone tendon junction;Group B with CTGF inject into bone tendon junction; C group was inject nothing. The animal of three groups were used surgery and all of the animals were faced with biomechanical test after 4 weeks, 8 weeks and 12 weeks; The result were used statistical analysis. RESULTS: group A and group B's cross-sectional area were lower than group C during 4 weeks, 12 weeks postoperative; there were statistical difference between each groups ( P < 0. 05). group Aand group B's pulled off load and ultimate tensile stress were higher than group C during 4 weeks, 8 weeks, 12 weeks postoperative, the result were statistical difference between each groups ( P < 0. 05). CONCLUSION: SOX9 and CTGF group can not only promote the early bone ten-don junction healing, But also increased the biomechanical strength of bone tendon junction.