Analysis of 82 cases of femoral trochanteric fracture treated with dynamic hip screw

Gu Jiazhen, Xia Zhengyuan, Huang Haibo, et al. Effect of Compound Danshen on Serum Endothelin and Thromboxane Levels in Patients Undergoing Cardiopulmonary Bypass Chinese Journal of Anesthesiology, 1998, 18: 722-724. Fu Runqiao, Ma Zicheng, Jin Shizhen. The effect of anesthesia on atrial natriuretic secretion. Foreign Medical Anesthesiology and Resuscitation Volume, 1997, 18: Wang Jianbo, Gai Ronghua, Lai Qingge. Effects of propofol on blood pressure, heart rate, and endothelium-dependent vascular regulation. Journal of Clinical Anesthesiology, 2000, Analysis of 82 cases of femoral trochanteric fractures treated with dynamic hip screw Shen Wendong (Department of Orthopaedics, Suzhou Hospital, Nanjing Medical University, Jiangsu dynamic hip screw; femoral trochanteric fracture; internal fixation has been adopted by the majority of orthopedic surgeons. August 1994 In December 2000, 82 patients with femoral trochanteric fractures were treated with DHS. The results were satisfactory. The report is as follows.

1 data and methods 1.1 general information are closed fractures, according to Boyd and Griffin classification, E type 36 cases, "type 22 cases, type 24 cases.

1.2 The material is made of domestic 130. Pressurized sliding goose nail, DHS thread nail length is 8 10cm, sleeve steel plate length is 310 holes.

1.3 surgical methods surgical continuous epidural anesthesia. The patient was placed in a traction bed and closed under fluoroscopy of the *C* arm. The lateral incision of the hip is taken. If the fracture continues to the femoral shaft, the incision is longitudinally extended to the distal end of the femur, and the upper trochanter and the upper part of the femur are exposed. The angle of the needle is determined by the angle meter, that is, 130., arrogant under the perspective of the *C* arm machine Under the rotor, pay attention to the anteversion angle of 23cm. Drill the guide needle into the direction of the femoral moment through the angle meter. The needle tip is 1.01.5cm below the cartilage of the femoral head. Select the corresponding length DHS thread nail to adjust the length of the combined cutter, reaming and tapping. Screw in, place the sleeve steel plate, press the fracture surface and press it to the outside of the femoral shaft to fix the screw tail screw. The *C* arm machine fluoroscopy was performed again before suturing the incision to confirm the reset and the fixation was satisfactory.

2 Results The incision was healed in the first stage. After the operation, the ''Ding' word shoe was fixed for 2 weeks. If the internal fixation was firm for 1 week, it could be seated and the lower limb muscles could be exercised. After 8 weeks, the X-ray film could be gradually formed. Weight-bearing walking, such as severe crushing of the medial small trochanter fracture, should be extended for 34 weeks during the fixation. After 6 months to 3 years of follow-up, according to the standard of clinical fracture healing, 82 fractures healed, and the average healing time was 13 weeks. No hip varus occurred, no plate screw fracture, bending, nail plate separation phenomenon.

According to the evaluation criteria of Huang Gongyi, the clinical efficacy was excellent: 58 cases; good: 24 cases; poor: no in this group. This group of 16 patients received internal fixation in our hospital after 1420 months, no further fractures.

Gamma nails are currently the ideal internal fixation material for internal fixation. However, when the upper end of the femur fixed by the Gamma nail is loaded, the stress on the femoral shaft at the proximal end of the intramedullary rod is abnormally increased, which tends to cause stress concentration and fracture of the bone of the interlocking nail. Radford et al. compared the DHS and Gamma nails. The efficacy of the two was similar. It is recommended that DHS.Jacobs and other biomechanical studies and clinical applications are recommended for the current rotor fractures. It is confirmed that the fixation effect of the Richards nail is stronger than that of the Jewett nail. Muller believes that A0 130. steel plate, A095. steel plate treatment of femoral trochanter fractures more complications, and that DHS is the best nail for the treatment of femoral rotor fractures. Xu Yuxiang and others believe that the internal fixation of the fracture must be fixed on the pressure side of the broken bone block, otherwise it will lead to internal fixation failure. The author believes that intraoperative reduction and fixation of small rotor fractures is very important, if necessary, bone grafting. At present, the first hole above the domestic DHS sleeve steel plate is far away from the thick screw, and does not have a foramen ovale. It cannot change the direction of the screw. It is not conducive to fixing the small rotor through the steel plate. It can be used from the anterior to the posterior aspect of the greater trochanter. The lag screw resets the small rotor and conforms to the A0 fixing principle.

For comminuted fractures that continue into the femoral shaft, a considerable portion is from the posterior superior to the sagittal plane fracture, and the length of the sleeve plate is sufficient. This group sometimes uses sleeve steel plate up to 10 holes, but it is necessary to prevent the rotation of the lower extremities. First of all, the anatomical reduction is attempted during the operation. If it is indeed difficult to dissect the anatomy, the axis of the fracture should be adjusted according to the axis of the lower extremity.

The purpose of internal fixation is to maintain the stability of the reduction until the bone is healed. It cannot rely on the DHS internal fixation early weight, nor can it be based on the postoperative time to determine whether it can bear the weight. It is necessary to formulate the ground load timing according to the clinical and epiphyseal growth conditions. The weight must be based on the condition of bone healing. This group of cases is relatively late with the journal of Nanjing Medical University, effectively avoiding the failure of internal fixation.

Dong Tianhua. Comments on several issues in fracture treatment. Chinese Journal of Orthopaedics, 1996, 16 (4): 203. Xu Zaixiang, Liu Yi, Li Changsheng, and so on. There are several basic problems in the current treatment of internal fixation of fractures. Chinese Journal of Orthopaedics, 1996, 16(4): 204 Diagnosis and treatment of chronic extended intracerebral hematoma Liu Xiguang, Chen Wei, Li Aimin, Shi Hui, Chen Jun (Lianyungang First People's Hospital Brain Surgery, Jiangsu Lianyungang Brain) Hemorrhage; intracerebral hematoma; diagnosis; treatment in December 1995, April 2001, a total of 14 cases, now on its etiology, clinical symptoms, diagnosis and treatment, combined with the relevant analysis discussed below.

1 data and methods ~ 45 years old, with an average age of 32.2 years. The onset time was 15 days and 2 years, with an average of 190 days. The lesions were located in 4 cases of temporal lobe, 2 cases of frontal lobe, 3 cases of parietal lobe, 2 cases of frontal parietal lobe, 1 case of cerebellar vermis, and 2 cases of occipital lobe. The lesion size was 2.5cmx2.0cmx3.0cm7.5cmx7.0cmx6.0cm, with an average of 4.0cmx5.5cmx5.0cm. Main symptoms and signs: intermittent headache and vomiting in 7 cases, progressive limb weakness in 9 cases, and epileptic seizure in 6 cases. 1 case of dyslexia, 5 cases of papilledema.

All the 14 cases underwent radiographic computed tomography (CT) examination. The lesions were round or round in 10 cases, irregular shape in 4 cases, lesions in equal low density in 3 cases, and mixed density in 11 cases. There were 6 cases of high-density shadow in the density area and 2 cases of high-low density mixing. There were different degrees of cerebral edema around 14 lesions, and there were different degrees of mass effect in the ventricle compression or midline structure shift. Twelve patients underwent CT-enhanced scanning. Ten of them showed an annular enhancement zone. Four lesions showed no enhancement, and six of them showed a patchy or plaque enhancement within the annular enhancement.

Four cases underwent 2 CT examinations, and the extent of the annular enhancement band was widened and the lesions were enlarged. Eight patients underwent head magnetic resonance imaging (MRI) examination, 5 cases of Ti and T2-weighted mixed signals, 3 cases of Ti-weighted image low signal and T2 weighted image, and 8 cases of T1 and T2 weighted images were seen around the lesion. Low signal or no signal band. Five cases of digital subtraction angiography (DSA) showed no abnormal vascular shadows in the cerebral vessels, but showed a mass effect, and the surrounding ring was stained.

All 14 patients underwent craniotomy. Four of them were treated conservatively and were treated with surgery after failure. During the operation, the center of the lesion was brown liquid or mixed blood clot. Among them, 6 cases were brown liquid, 4 cases were old blood clots, 3 cases were mixed with old blood clots, fresh bleeding, and separated and mixed with blood clots. 12 cases had thick and uneven capsules, of which 8 cases were thicker, 4 cases were thin layer of gelatinous tissue, and 2 cases were not obvious. Under the microscope, 8 cases had abnormal small deformed blood vessels on the outer and inner sides of the capsule, and 7 cases found suspicious vascular malformations in the center of the lesion. The capsule, suspicious lesions and clots were sent for examination. The pathological examination showed that the capsule was dense connective tissue, and the inner wall contained hemosiderin. The deformed blood vessels of various sizes were distributed in the inner and outer layers of the capsule, and some blood vessels were present. Thrombosis, mechanization, tissue inflammatory cell infiltration. 9 cases of vascular malformation and 2 cases of cerebral atherosclerosis were found in the clots and suspicious objects.

2 Results Of the 14 cases, 11 cases were cured, 3 cases improved; 10 cases fully recovered, 3 cases were able to participate in different levels of work, and 1 case was moderately disabled. 12 patients were followed up after discharge from 2 months to 5 years. No abnormal signs were found in the head CT.

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