Purpose： To compare the clinical effects of long vs. short intramedullary nails in the treatment of intertrochanteric fractures in old patients more than 65 years old. Methods： A retrospective analysis of 178 cases ...Purpose： To compare the clinical effects of long vs. short intramedullary nails in the treatment of intertrochanteric fractures in old patients more than 65 years old. Methods： A retrospective analysis of 178 cases of intertrochanteric fractures of the femur （AO type AI and A2） in the elderly was conducted from January 2008 to December 2013. There were 85 males （47.8%） and 93 females （52.2%） with the age of 65-89 （70.2 ±10.8） years. The patients were treated by closed reduction and long or short intramedullary nail （Gamma 3） fixation. The length of short nail was 180 mm and that for long nail was 320-360 ram. The general data of patients, operation time, intraoperative blood loss, length of hospital stay, preoperative hemoglobin level, blood transfusion rate, postoperative periprosthetic fractures, infections, complications, etc were carefully recorded. Results： There were 76 cases （42.7%） in the long intramedullary nail group and 102 cases （57.3%） in the short nail group. All the cases were followed up for 12-48 （21.3 ± 6.8） months, during which there were 21 deaths （11.8%）, mean （13.8 ± 6.9） months after operation. The intraoperative blood loss was （90.7±50.6） ml in short nail group, greatly less than that in long nail group （127.8 _＋ 85.9） ml （p 0.004）. The short nail group also had a significantly shorter operation time （43.5 min ± 12.3 min vs. 58.5 rain ± 20.3 min, p = 0.002） and lower rate of postoperative transfusion （42.3% vs. 56.7%, p =0.041 ）. But the length of hospital stay showed no big differences. After operation, in each group there was 1 case of periprosthetic fracture with a total incidence of 1.1%, 1.3%; in long nail group and 0.9% in short nail group. At the end of the follow-up, all patients achieved bony union. The average healing time of the long nail group was （6.5 ±3.1 ） months, and the short nail group was （6.8 ± 3.7） months, revealing no sig- nificant differences （p = 0.09）. Postoperative complications showed no great differences either. Conclusion： Both the intramedullary long and short nail fixation has a good clinical effect in treating intertrochanteric femur fractures in the elderly. They showed no significant difference in terms of therapeutic effect, hospital stay and postoperative complications. The incidence of periprosthetic frac- tures treated by either length of nails was low. But short intramedullary nailing can obviously decrease the intraooerative blood loss, ooeration time and postooerative blood transfusion.展开更多
Purpose:To compare the stability of the posterior anatomic self-locking plate(PASP)with two types of popular reconstruction plate fixation,i.e.double reconstruction plate(DRP)and cross reconstruction plate(CRP),and to...Purpose:To compare the stability of the posterior anatomic self-locking plate(PASP)with two types of popular reconstruction plate fixation,i.e.double reconstruction plate(DRP)and cross reconstruction plate(CRP),and to explore the influence of sitting and turning right/left on implants.Methods:PASP,DRP and CRP were assembled on a finite element model of both-column fractures of the left acetabulum.A load of 600 N and a torque of 8 N·m were loaded on the S1 vertebral body to detect the change of stress and displacement when sitting and turning right/left.Results:The peak stress and displacement of the three kinds of fixation methods under all loading conditions were CRP>DRP>PASP.The peak stress and displacement of PASP are 313.5 MPa and 1.15 mm respectively when turning right;and the minimal was 234.0 Mpa and 0.619 mm when turning left.Conclusion:PASP can provide higher stability than DRP and CRP for both-column acetabular fractures.The rational movement after posterior DRP and PASP fixation for acetabular fracture is to turn to the ipsilateral side,which can avoid implant failure.展开更多
文摘Purpose： To compare the clinical effects of long vs. short intramedullary nails in the treatment of intertrochanteric fractures in old patients more than 65 years old. Methods： A retrospective analysis of 178 cases of intertrochanteric fractures of the femur （AO type AI and A2） in the elderly was conducted from January 2008 to December 2013. There were 85 males （47.8%） and 93 females （52.2%） with the age of 65-89 （70.2 ±10.8） years. The patients were treated by closed reduction and long or short intramedullary nail （Gamma 3） fixation. The length of short nail was 180 mm and that for long nail was 320-360 ram. The general data of patients, operation time, intraoperative blood loss, length of hospital stay, preoperative hemoglobin level, blood transfusion rate, postoperative periprosthetic fractures, infections, complications, etc were carefully recorded. Results： There were 76 cases （42.7%） in the long intramedullary nail group and 102 cases （57.3%） in the short nail group. All the cases were followed up for 12-48 （21.3 ± 6.8） months, during which there were 21 deaths （11.8%）, mean （13.8 ± 6.9） months after operation. The intraoperative blood loss was （90.7±50.6） ml in short nail group, greatly less than that in long nail group （127.8 _＋ 85.9） ml （p 0.004）. The short nail group also had a significantly shorter operation time （43.5 min ± 12.3 min vs. 58.5 rain ± 20.3 min, p = 0.002） and lower rate of postoperative transfusion （42.3% vs. 56.7%, p =0.041 ）. But the length of hospital stay showed no big differences. After operation, in each group there was 1 case of periprosthetic fracture with a total incidence of 1.1%, 1.3%; in long nail group and 0.9% in short nail group. At the end of the follow-up, all patients achieved bony union. The average healing time of the long nail group was （6.5 ±3.1 ） months, and the short nail group was （6.8 ± 3.7） months, revealing no sig- nificant differences （p = 0.09）. Postoperative complications showed no great differences either. Conclusion： Both the intramedullary long and short nail fixation has a good clinical effect in treating intertrochanteric femur fractures in the elderly. They showed no significant difference in terms of therapeutic effect, hospital stay and postoperative complications. The incidence of periprosthetic frac- tures treated by either length of nails was low. But short intramedullary nailing can obviously decrease the intraooerative blood loss, ooeration time and postooerative blood transfusion.
文摘Purpose:To compare the stability of the posterior anatomic self-locking plate(PASP)with two types of popular reconstruction plate fixation,i.e.double reconstruction plate(DRP)and cross reconstruction plate(CRP),and to explore the influence of sitting and turning right/left on implants.Methods:PASP,DRP and CRP were assembled on a finite element model of both-column fractures of the left acetabulum.A load of 600 N and a torque of 8 N·m were loaded on the S1 vertebral body to detect the change of stress and displacement when sitting and turning right/left.Results:The peak stress and displacement of the three kinds of fixation methods under all loading conditions were CRP>DRP>PASP.The peak stress and displacement of PASP are 313.5 MPa and 1.15 mm respectively when turning right;and the minimal was 234.0 Mpa and 0.619 mm when turning left.Conclusion:PASP can provide higher stability than DRP and CRP for both-column acetabular fractures.The rational movement after posterior DRP and PASP fixation for acetabular fracture is to turn to the ipsilateral side,which can avoid implant failure.
