Dynamic hip screw internal fixation combined with cement filling for the treatment of femoral intertrochanteric comminuted fractures in the elderly Chen Wenzhao Key words femoral fracture fracture fixation, internal / method elderly intertrochanteric fractures are more common in the elderly, mostly comminuted, fracture site easy A bone defect is formed. At the time of surgical reduction, due to the use of a method such as swaying, the defect of the fracture site may be increased, resulting in difficulty in implantation of the internal fixation or loosening after implantation. After adding bone cement, the authors were satisfied with the results.
1 Materials and Methods 1.1 Clinical data From October 1999 to August, our hospital applied dynamic hip screw (DHS) internal fixation plus cement cement to treat 14 cases of comminuted intertrochanteric fractures in the elderly, including 5 males and 9 females. Example; age 70 to 87 years old, average 76 years old. According to AO classification, A2. 3 type 2 cases. There were 2 cases of diabetes and 3 cases of hypertension before operation. After medical treatment, blood sugar and blood pressure were controlled in the normal range. Severe heart and brain disorders were excluded in all cases.
1.2 Surgical method After epidural anesthesia, take the Yangchen Bu position, put the lower limbs on the "hip reduction frame", and correct the obvious shortening, varus or valgus deformity under the perspective of C-arm machine. Under the hip pad sandbag, try to correct the femoral neck anteversion to 0* position. After the lateral incision enters the exposed fracture site, it is reset by directing and patching under direct vision, and the fracture end is repeatedly washed with physiological saline, and sucked dry with a suction device to prepare bone cement to fill the bone quickly by hand. The defect is placed, and the larger broken bone piece that can be put back is put back to the original position, and the fracture end is fixed in place by hand or instrument. After the bone cement is solidified, the DHS is fixedly placed. Regularly enter the positioning guide pin, see through the satisfactory follow-up pin reaming, wire tapping, screwing into the appropriate length of the screw, place the DHS plate on the positive side of the femur, and fix it with the cortical bone screw, and finally install the tail nail. If it is found that the large trochanter has a large fracture block separation and displacement, it can be fixed by tension wire.
2 Results All 14 patients were followed up for 3 to 20 months. All the surgical incisions healed in the first stage, and there were no symptoms of blood vessel and nerve damage caused by surgery. There was no obvious hip pain, hip varus or hip valgus and shortened deformity of the lower limbs after operation. The hip joint activity was good and the walking function was good. Imaging examination: 14 cases were obtained by radiological fusion, and the healing time was 3-6 months. There is no internal fixation fracture, looseness, slipping appearance, the hip neck dry angle is basically normal, and there is no femoral head necrosis.
3 Discussion 3.1 Indications This procedure is applicable to comminuted intertrochanteric fractures in the elderly. Since the contact surface of the comminuted osteogenesis and the screw is reduced, the occlusal force is lowered, so that the fixation effect is not obtained. The cement packing method can effectively ensure the firmness of the nail board structure.
3.2 Several problems in the operation of the operation 1 surgery should be carried out under the supervision of the C-arm machine. After filling the bone cement, whether it is reaming, tapping, or screwing into the screw, the feel is different from that in the cancellous bone, so the operation under the perspective of the C-arm machine is the key to the success of the operation. 2 first fill the cement back screws. When the screw passes through the bone cement, the hand feels similar to the cortical bone. As long as the hole is first expanded and the wire is tapped, the bone cement does not have a large influence on the insertion of the screw. The placement of the 3 tail nails is an important step. Some people think that without the spike, the screw hole can slide in the nail plate, which can automatically press the fracture end. But for older patients with osteoporosis, stability is far more important than early healing. The blood supply to the intertrochanteric fracture is better, as long as the effective fixation, the possibility of bone nonunion and femoral head necrosis is minimal.
3.3 Application of Bone Cement 1 Manually adjust the method. When it enters the “seed periodâ€, fill it into the defect of the bone by hand, and try not to leak into the surrounding soft tissue. 2 Before filling the bone cement, rinse the area to be filled with physiological saline several times and blot it with an aspirator to enhance the adhesion strength of the bone cement. 3 intraoperative monitoring of blood pressure to prevent transient blood pressure fluctuations. This group did not find the toxicity of bone cement 15300 Zhejiang Cixi Traditional Chinese Medicine Hospital (Flush) Shanghai Huashan Hospital (Chen Wenxuan) all over the time to create 11 and allergic reactions.
3.4 postoperative rehabilitation exercise 24~48h postoperative drainage tube, bed reversal and mild activity within 2 weeks, 2 weeks later in the doctor's guidance down the bed muscle and joint functional exercise, conditional available passive passive motor machine joint Passive activity. After 6 weeks, get off the bed and turn the weight to support the standing and standing activities. Be sure to take full weight-bearing walking after X-ray film confirms signs of bone healing.
Clinical analysis of 58 cases of placenta previa. Yu Lianju Shen Pingrong's topical placenta, pre-pregnancy / cesarean section delivery antenatal placenta is one of the common causes of late pregnancy bleeding, improper treatment can endanger the mother and fetal life. The authors retrospectively analyzed 58 cases of placenta previa in the two hospitals from 1998 to 2000.
1 Clinical data General information The total number of cases of delivery in two hospitals in 3 years was 2888 cases, including 58 cases of placenta previa, the incidence rate was 2.0%. 58 cases of pregnant women aged 20 years of maternal history 35 cases, 23 cases of maternal. There were 52 cases of abortion history, accounting for 89.7%. 1.3 vaginal bleeding occurred in 10 cases of 28 to 32 weeks of pregnancy, 13 cases of 33 to 37 weeks, 35 cases (60.3%) of more than 37 weeks of bleeding 1.4 front Placental type central placenta previa 21 cases (36.2%) partial placenta previa 23 cases (39.7%) marginal placenta previa 14 cases 1.5 treatment 58 cases were hospitalized. Less than 37 weeks of gestation are treated with a tocolytic inhibitor to mature the fetus. Among the 58 cases, marginal placenta previa with less vaginal bleeding was vaginal delivery in 13 cases, and another 45 cases (81.8%) underwent cesarean section. In the operation, Chuan Center Health Center (Yulianju) Zhejiang Ninghai County First Hospital (Zhen Pingrong), 18 cases of major bleeding, including 16 cases of uterine artery ligation and uterine cavity gauze, successfully hemostasis; In 58 cases, 8 cases were combined with placenta, and 2 cases with small placenta and small bleeding were ligated with uterine artery ascending branch and the uterine wall of the implant was conically cut; the other 6 cases were uterus cut.
1.6 Newborns in 58 cases, 6 cases of perinatal death, mortality 10.4%; 23 cases of premature infants (39.7%), 13 cases of low birth weight (22. 1.7 prognosis and sputum infection 4 cases. All women were cured and discharged The average hospital stay was 27.5 days.
2 Discussion 2.1 The incidence of placenta previa was reported to be 0.24%-1.57%. Obstetrics and Gynecology. 4th edition. Beijing: People's Medical Publishing House, 1996.122. Chinese Journal of Practical Gynecology and Obstetrics, Principles to Follow J. Journal of Modern Surgery, 19961(2): 77*79.
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