Objective To compare the efficacy of 3 internal fixations,locking proximal femoral plate (LPFP),ASI-AN IMHS and InterTAN,for intertrochanteric femoral fractures in elderly patients.Methods A retrospective study was do...Objective To compare the efficacy of 3 internal fixations,locking proximal femoral plate (LPFP),ASI-AN IMHS and InterTAN,for intertrochanteric femoral fractures in elderly patients.Methods A retrospective study was done to analyse展开更多
Purpose:To investigate the clinical value of proximal femoral nail antirotation and anatomical locking plate of proximal femur in the treatment of intertrochanteric fracture of femur.Methods:The study group is treated...Purpose:To investigate the clinical value of proximal femoral nail antirotation and anatomical locking plate of proximal femur in the treatment of intertrochanteric fracture of femur.Methods:The study group is treated with PFNA internal fixation.The control group is treated by internal fixation with anatomical locking plate of proximal femur.Results:The time of operation,the amount of intraoperative bleeding and the time of fracture healing in the study group are significantly less than those in the control group.The incidence rate of complication in the study group(3.23%)is significantly lower than that in the control group(17.2%).Data comparison shows P<0.05.Conclusion:The curative effect and prognosis for patients with intertrochanteric fracture of femur treated by PFNA internal fixation are more ideal.展开更多
Purpose To investigate the clinical value of proximal femoral nail antirotation and anatomical locking plate of proximal femur in the treatment of intertrochanteric fracture of femur.Methods The study group is treated...Purpose To investigate the clinical value of proximal femoral nail antirotation and anatomical locking plate of proximal femur in the treatment of intertrochanteric fracture of femur.Methods The study group is treated with PFNA internal fixation.The control group is treated by internal fixation with anatomical locking plate of proximal femur.Results The time of operation,the amount of intraoperative bleeding and the time of fracture healing in the study group are significantly less than those in the control group.The incidence rate of complication in the study group(3.23%)is significantly lower than that in the control group(17.2%).Data comparison shows P<0.05.Conclusion The curative effect and prognosis for patients with intertrochanteric fracture of femur treated by PFNA internal fixation are more ideal.展开更多
Plate and screw constructs are routinely used in the treatment of long bone fractures. Despite considerable advancements in technology and techniques, there can still be complications in the healing of long bone fract...Plate and screw constructs are routinely used in the treatment of long bone fractures. Despite considerable advancements in technology and techniques, there can still be complications in the healing of long bone fractures. Non-unions, delayed unions, and hardware failures are common complications observed in clinical practice following open reduction and internal fixation of fractures [1]. Potential causes of these adverse clinical effects may be disruptive to the periosteal and endosteal blood supply, stress shielding effects, and inadequate mechanical stability. The goal of the present study was to explore the effect of screw position on the fracture healing and formation of new bone tissue with mechanoregulatory algorithms in a computational model. An idealized poroelastic 3D finite element (FE) model of a femur with a 5 mm fracture gap, including a plate-screw construct was developed. Nineteen different plate-screw combinations, created by varying the number and position of screws within the plate, were created to identify a construct with the most favourable attributes for fracture healing. The first phase of the study evaluated constructs through mechanical stress analyses to identify those constructs with high loadsupport capability. The second phase of the study evaluated healing and bone formation with a biphasic mechanoregulatory algorithm to simulate tissue differentiation for fixation within selected constructs. The results of our analysis demonstrated a 4-screw symmetrical construct with the largest distance between screws to provide the most favourable balance of stability and optimized conditions to promote fracture healing.展开更多
Purpose: The proximal femoral nail anti-rotation (PFNA) is known to have advantages in enhancing the anchorage ability of internal fixation in elderly unstable osteoporotic intertrochanteric fracture patients. However...Purpose: The proximal femoral nail anti-rotation (PFNA) is known to have advantages in enhancing the anchorage ability of internal fixation in elderly unstable osteoporotic intertrochanteric fracture patients. However whether it is superior to condylar blade fixation is not clear. This study aimed to determine which treatment has better clinical outcomes in older patients. Materials and Methods: A total of 86 patients over the age of 60 with unstable trochanteric fractures within the past 3 weeks, were included in this prospective study conducted from June 1, 2018, to May 31, 2021. All the intertrochanteric fractures were classified according to AO/OTA classification. Among them, 44 cases were treated with the Proximal Femoral Nail (PFNA2) with or without an augmentation screw, and 42 cases were treated with the Condylar Blade Plate. In addition, the operative time, intraoperative blood loss, intraoperative and postoperative blood transfusion, postoperative weight-bearing time, hospitalization time, Harris score of hip function, Kyle’s criteria and postoperative complications were compared between the two groups. Results: The mean duration of surgery for the PFN group was 66.8 minutes (on average), whereas for the condylar blade plate group, it was 99.30 minutes (on average). The PFNA2 group experienced less blood loss (average of 80 mL) compared to the condylar blade plate group (average of 120 mL). Union and partial weight-bearing occurred earlier in the PFNA2 group (14.1 weeks and 10.6 weeks, respectively) compared to the Condylar blade plate group (18.7 weeks and 15.8 weeks). In two patients from the PFNA2 group, screw backing out and varus collapse complications were encountered;however, these patients remained asymptomatic and did not require revision surgery. In two other patients, screw cut out and breakage of the nail at the helical screw hole leading to non-union of the proximal femur were observed during the nine-month follow-up, necessitating revision surgery with prosthetic replacement. Among the condylar blade plate group, three patients experienced complications, including blade breakage at the blade and plate junction. In two cases, the fracture united in varus, and in one case, the blade cut through, resulting in non-union of the femoral head, which required revision surgery. According to the Harris hip score and Kyle’s criteria, a good-excellent outcome was observed in 92.85% of cases in the PFNA2 group and 90.90% of cases in the condylar blade plate group. Conclusion: Both the Proximal Femoral Nail A2 and Condylar blade plate are effective implants for the treatment of unstable trochanteric fractures. The intramedullary implant promotes biological healing and allows for early ambulation with minimal complications. Similarly satisfactory restoration of anatomy and favorable radiological and functional results can be achieved with the biological fixation provided by the 95-degree condylar blade plate. However, the use of PFNA2 internal fixation technique has the advantage of less trauma in elderly patients than the 95-degree condylar blade plate.展开更多
The number and spatial configuration of the screws will affect the stability and prognosis of the fractures.In our study,we assessed the biomechanical effects of the double-head cannulated compression screw(DhCCS)and ...The number and spatial configuration of the screws will affect the stability and prognosis of the fractures.In our study,we assessed the biomechanical effects of the double-head cannulated compression screw(DhCCS)and ordinary cannulated compression screw(OCCS)for the treatment of femoral neck fractures by using computer finite element analysis.The original digital imaging and communications in medicine(DICOM)data of a proximal femur were imported into Materialise’s interactive medical image control system(MIMICS)software for modeling.Both DhCCS and OCCS 3D-models were obtained by using the 3D scan technique.Using the fracture model and internal fixation assembly model with an inverted triangle,two horizontal and vertical distribution were established in UG software.Next,the displacement and stress distribution were calculated in ANSYS software.The displacement value of the femoral head in the DhCCS group was smaller than that in the OCCS group,and the displacement value in the two horizontal groups was smaller than that in the vertical group.The stress distribution in the DhCCS group was concentrated on the screw rod at the fracture block and thread end,while only at the fracture block in the OCCS group.The stress in the horizontal group was more dispersed on the screws than that in the vertical group.DhCCS has reliable stability for the fixation of femoral neck fractures and applied in the clinical work and 2 horizontal fixation can be used when two screws are selected.展开更多
目的:对比鞘内注射舒芬太尼与芬太尼对高龄股骨粗隆骨折近端股骨钉抗旋(PFNA)内固定术患者的镇痛效果及安全性对比。方法:选取2019年1月—2022年12月于常熟市第五人民医院接受股骨粗隆骨折PFNA内固定术的108例高龄患者作为研究对象,根...目的:对比鞘内注射舒芬太尼与芬太尼对高龄股骨粗隆骨折近端股骨钉抗旋(PFNA)内固定术患者的镇痛效果及安全性对比。方法:选取2019年1月—2022年12月于常熟市第五人民医院接受股骨粗隆骨折PFNA内固定术的108例高龄患者作为研究对象,根据随机数表法将患者分为研究组54例与常规组54例。研究组采用鞘内注射舒芬太尼,常规组采用鞘内注射芬太尼。比较两组手术时间、镇痛时间、术后6 h、12 h视觉模拟评分法(VAS)评分及不良反应发生情况。结果:两组手术时间比较,差异无统计学意义(P>0.05);研究组镇痛时间长于常规组,差异有统计学意义(P<0.05)。研究组术后6 h、12 h VAS评分低于常规组,且两组术后12 h VAS评分低于术后6 h,差异有统计学意义(P<0.05)。研究组不良反应发生率低于常规组,差异有统计学意义(P<0.05)。结论:相比芬太尼,舒芬太尼在高龄股骨粗隆骨折PFNA内固定术患者中的镇痛作用显著,能缓解术后疼痛,还可降低不良反应发生率。展开更多
文摘Objective To compare the efficacy of 3 internal fixations,locking proximal femoral plate (LPFP),ASI-AN IMHS and InterTAN,for intertrochanteric femoral fractures in elderly patients.Methods A retrospective study was done to analyse
文摘Purpose:To investigate the clinical value of proximal femoral nail antirotation and anatomical locking plate of proximal femur in the treatment of intertrochanteric fracture of femur.Methods:The study group is treated with PFNA internal fixation.The control group is treated by internal fixation with anatomical locking plate of proximal femur.Results:The time of operation,the amount of intraoperative bleeding and the time of fracture healing in the study group are significantly less than those in the control group.The incidence rate of complication in the study group(3.23%)is significantly lower than that in the control group(17.2%).Data comparison shows P<0.05.Conclusion:The curative effect and prognosis for patients with intertrochanteric fracture of femur treated by PFNA internal fixation are more ideal.
文摘Purpose To investigate the clinical value of proximal femoral nail antirotation and anatomical locking plate of proximal femur in the treatment of intertrochanteric fracture of femur.Methods The study group is treated with PFNA internal fixation.The control group is treated by internal fixation with anatomical locking plate of proximal femur.Results The time of operation,the amount of intraoperative bleeding and the time of fracture healing in the study group are significantly less than those in the control group.The incidence rate of complication in the study group(3.23%)is significantly lower than that in the control group(17.2%).Data comparison shows P<0.05.Conclusion The curative effect and prognosis for patients with intertrochanteric fracture of femur treated by PFNA internal fixation are more ideal.
文摘Plate and screw constructs are routinely used in the treatment of long bone fractures. Despite considerable advancements in technology and techniques, there can still be complications in the healing of long bone fractures. Non-unions, delayed unions, and hardware failures are common complications observed in clinical practice following open reduction and internal fixation of fractures [1]. Potential causes of these adverse clinical effects may be disruptive to the periosteal and endosteal blood supply, stress shielding effects, and inadequate mechanical stability. The goal of the present study was to explore the effect of screw position on the fracture healing and formation of new bone tissue with mechanoregulatory algorithms in a computational model. An idealized poroelastic 3D finite element (FE) model of a femur with a 5 mm fracture gap, including a plate-screw construct was developed. Nineteen different plate-screw combinations, created by varying the number and position of screws within the plate, were created to identify a construct with the most favourable attributes for fracture healing. The first phase of the study evaluated constructs through mechanical stress analyses to identify those constructs with high loadsupport capability. The second phase of the study evaluated healing and bone formation with a biphasic mechanoregulatory algorithm to simulate tissue differentiation for fixation within selected constructs. The results of our analysis demonstrated a 4-screw symmetrical construct with the largest distance between screws to provide the most favourable balance of stability and optimized conditions to promote fracture healing.
文摘Purpose: The proximal femoral nail anti-rotation (PFNA) is known to have advantages in enhancing the anchorage ability of internal fixation in elderly unstable osteoporotic intertrochanteric fracture patients. However whether it is superior to condylar blade fixation is not clear. This study aimed to determine which treatment has better clinical outcomes in older patients. Materials and Methods: A total of 86 patients over the age of 60 with unstable trochanteric fractures within the past 3 weeks, were included in this prospective study conducted from June 1, 2018, to May 31, 2021. All the intertrochanteric fractures were classified according to AO/OTA classification. Among them, 44 cases were treated with the Proximal Femoral Nail (PFNA2) with or without an augmentation screw, and 42 cases were treated with the Condylar Blade Plate. In addition, the operative time, intraoperative blood loss, intraoperative and postoperative blood transfusion, postoperative weight-bearing time, hospitalization time, Harris score of hip function, Kyle’s criteria and postoperative complications were compared between the two groups. Results: The mean duration of surgery for the PFN group was 66.8 minutes (on average), whereas for the condylar blade plate group, it was 99.30 minutes (on average). The PFNA2 group experienced less blood loss (average of 80 mL) compared to the condylar blade plate group (average of 120 mL). Union and partial weight-bearing occurred earlier in the PFNA2 group (14.1 weeks and 10.6 weeks, respectively) compared to the Condylar blade plate group (18.7 weeks and 15.8 weeks). In two patients from the PFNA2 group, screw backing out and varus collapse complications were encountered;however, these patients remained asymptomatic and did not require revision surgery. In two other patients, screw cut out and breakage of the nail at the helical screw hole leading to non-union of the proximal femur were observed during the nine-month follow-up, necessitating revision surgery with prosthetic replacement. Among the condylar blade plate group, three patients experienced complications, including blade breakage at the blade and plate junction. In two cases, the fracture united in varus, and in one case, the blade cut through, resulting in non-union of the femoral head, which required revision surgery. According to the Harris hip score and Kyle’s criteria, a good-excellent outcome was observed in 92.85% of cases in the PFNA2 group and 90.90% of cases in the condylar blade plate group. Conclusion: Both the Proximal Femoral Nail A2 and Condylar blade plate are effective implants for the treatment of unstable trochanteric fractures. The intramedullary implant promotes biological healing and allows for early ambulation with minimal complications. Similarly satisfactory restoration of anatomy and favorable radiological and functional results can be achieved with the biological fixation provided by the 95-degree condylar blade plate. However, the use of PFNA2 internal fixation technique has the advantage of less trauma in elderly patients than the 95-degree condylar blade plate.
基金This research was supported by the health and family planning commission of chongqing under grant 2016MSXM162.
文摘The number and spatial configuration of the screws will affect the stability and prognosis of the fractures.In our study,we assessed the biomechanical effects of the double-head cannulated compression screw(DhCCS)and ordinary cannulated compression screw(OCCS)for the treatment of femoral neck fractures by using computer finite element analysis.The original digital imaging and communications in medicine(DICOM)data of a proximal femur were imported into Materialise’s interactive medical image control system(MIMICS)software for modeling.Both DhCCS and OCCS 3D-models were obtained by using the 3D scan technique.Using the fracture model and internal fixation assembly model with an inverted triangle,two horizontal and vertical distribution were established in UG software.Next,the displacement and stress distribution were calculated in ANSYS software.The displacement value of the femoral head in the DhCCS group was smaller than that in the OCCS group,and the displacement value in the two horizontal groups was smaller than that in the vertical group.The stress distribution in the DhCCS group was concentrated on the screw rod at the fracture block and thread end,while only at the fracture block in the OCCS group.The stress in the horizontal group was more dispersed on the screws than that in the vertical group.DhCCS has reliable stability for the fixation of femoral neck fractures and applied in the clinical work and 2 horizontal fixation can be used when two screws are selected.
文摘目的:对比鞘内注射舒芬太尼与芬太尼对高龄股骨粗隆骨折近端股骨钉抗旋(PFNA)内固定术患者的镇痛效果及安全性对比。方法:选取2019年1月—2022年12月于常熟市第五人民医院接受股骨粗隆骨折PFNA内固定术的108例高龄患者作为研究对象,根据随机数表法将患者分为研究组54例与常规组54例。研究组采用鞘内注射舒芬太尼,常规组采用鞘内注射芬太尼。比较两组手术时间、镇痛时间、术后6 h、12 h视觉模拟评分法(VAS)评分及不良反应发生情况。结果:两组手术时间比较,差异无统计学意义(P>0.05);研究组镇痛时间长于常规组,差异有统计学意义(P<0.05)。研究组术后6 h、12 h VAS评分低于常规组,且两组术后12 h VAS评分低于术后6 h,差异有统计学意义(P<0.05)。研究组不良反应发生率低于常规组,差异有统计学意义(P<0.05)。结论:相比芬太尼,舒芬太尼在高龄股骨粗隆骨折PFNA内固定术患者中的镇痛作用显著,能缓解术后疼痛,还可降低不良反应发生率。
