PFNA-Ⅱ combined with preoperative accurate measurement evaluation for the treatment of senile femoral fractures between rotor

Objective:Research PFNA-Ⅱcombined with preoperative accurate measurement of senile femoral fracture between the rotor of the clinical application value.Methods:Fiftytwo patients with intertrochanteric fractures admitted to our hospital from January 2017 to October 2019 were selected and divided into the traditional group and the measurement group according to the random number table method,with 26 patients in each group.The traditional group could not make accurate measurement before operation,but the measurement group could make accurate measurement before operation.Postoperative follow-up was conducted for at least 6 months to compare The Times of intraoperative X-ray fluoroscopy,operation time,intraoperative blood loss,and TAD,Harris score and improved BADL score of the hip joint between the two groups.Results:The number of intraoperative X-ray fluoroscopy in the measured group was less than that in the conventional group(15.08+/-2.10 vs 19.81±2.21 times,t=7.920,P=0.000).The operation time of the measured group was lower than that of the traditional group(78.46+/-3.68 vs 89.62+/-5.28 minutes,t=8.841,P=0.000).Intraoperative blood loss was less in the measured group than in the conventional group(146.15+/-24.18 vs 163.46+/-22.62 ml,t=2.666,P=0.010).There was no statistically significant difference in TAD values between the two groups(23.73+/-2.49 vs 24.04+/-2.63 mm,t=0.433,P=0.667).There is no interaction between intervention mode and time factor(F=0.362,P=0.698).There was statistical difference in Harris scores between different timepoints before and after the operation,in other words,there was time effect(F=378.110,P=0.000).There was no statistical difference in Harris scores between the 2 groups,in other words,there was no group effect(F=0.874,P=0.354).All the Harris scores of the two groups increased with time,and the increase trend was consistent(39.69+/-3.27,68.27+/-5.06,82.54+/-6.21 points,F=49.333,P=0.000;39.15+/-3.46,67.00+/-4.24,80.84+/-7.12 points,F=53.460,P=0.000).There was no significant difference in the improved BADL score between the two groups 6 months after surgery(t=0.587,P=0.560).Conclusion:PFNA-Ⅱcombined with preoperative accurate measurement in the application of the elderly femoral fracture between the rotor is safe and effective,not only can shorten the operation time,less intraoperative blood loss and the number of perspective,while reducing the risks of medical radiation.

Early efficacy of endoscopic translaminar and intervertebral foraminal approaches in the treatment of lumbar disc herniation

Objective:To investigate the early efficacy of two approaches for lumbar disc herniation under spinal endoscopy.Methods:45 cases of lumbar disc herniation were divided into interlaminar approach(27 cases)and intervertebral foramen approach(18 cases)according to different surgical approaches.Postoperative pain visual analogue scale(VAS)was used.Japanese Orthopaedic Association(JOA)lumbar spine score(JOA)and modified Macnab criteria were used to evaluate the postoperative outcome.Results:(1)VAS score.There is no interaction effect between the access mode and the time factor(F=0.620,P=0.603).There were statistically significant differences in pain VAS scores between preoperative and postoperative time points,that is,there was a time effect(F=2157.488,P=0.000).The overall VAS scores of the two groups were compared,and the difference was not statistically significant,that is,there was no grouping effect(F=2.610,P=0.114).The VAS score of pain in both groups decreased with time,and the differences between the two groups were not statistically significant before surgery,at discharge,1 month after surgery and 3 months after surgery(t=0.067,P=0.947;t=1.415,P=0.164;t=0.564,P=0.575;t=0.442,P=0.660);JOA score.There is no interaction effect between the access mode and the time factor(F=1.296,P=0.280).The difference of JOA score between preoperative and postoperative time points was statistically significant,that is,there was a time effect(F=1464.830,P=0.000).JOA scores of the two groups showed an increasing trend with time,and the differences between the two groups were not statistically significant before surgery,at discharge,1 month after surgery and 3 months after surgery(t=0.067,P=0.947;t=1.415,P=0.164;t=0.564,P=0.575;t=0.442,P=0.660);(2)The improved Macnab standard was used to evaluate the excellent and good rate at 3 months after surgery.In the interlaminar group,12 cases were excellent,13 cases were good and 2 cases were fair.The excellent and good rate was 92.6%.In the intervertebral foramen group,7 cases were excellent,10 cases were good and 1 case was fair.The excellent and good rate was 94.4%.The overall excellent and good rate of the two groups was 93.3%.Conclusion:Both approaches can achieve satisfactory efficacy in the treatment of lumbar intervertebral disc herniation,which is worthy of clinical application.However,for beginners,l5-s1 lumbar disc herniation is more suitable for intervertebral disc approach,so as to achieve satisfactory efficacy.