Objective To evaluate the clinical effect of cannulatedscrew on treatment of femoral neck fracture(FNF). Methods Forty-two FNFpatients were treated by using cannulated screw from January 2001 to December 2005.There were 22males and 20 females with an average age of 41 years (19-59 years). Fracture was caused by traffic accident in 21 cases, by falling from height in 14 cases and by bruise in 7 cases. All cases were fresh fracture. According to Garden criterion for typing, 15 cases were classified as type Ⅱ, 16 cases as type Ⅲ and 11 cases as type Ⅳ . It was 7 hours to 15 days from injury to operation. Results Thepatients were followed up for 1-6 years with an average of 2.5 years. The average fracture union time was 6.5 months. Three patients had ischemic necrosis of femoral head, andloosening and breakage of screw and rob was observed in 1 case. According to Brumback criterion for hip joint function, the result was excellent in 18 cases, good in 20 cases and bad in 4 cases, and the excellent and good rate was 90.4%. Conclusion Cannulated screw fixation is a good method to treat FNF in young adults. It can improve the rate of fracture union and reduce the rate of avascular necrosis of femoral head.
Objective To compare heterotopic ossification between femoral head reconstruction and total hip arthroplasty(THA) in patients with ischemic necrosis of femoral head(INFH). Methods Between June 1994 and December 2004, the femoral heads were repaired in 1 005 patients with INFH,the total hip was replaced in 485 patients with INFH. The rate of heterotopic ossification was observed in 74 (Ficat Ⅲ to Ⅳ stages) of 1 005 patients and 80 of 485 patients given THA to compared the results of the two methods. Results These patients were followed up 2 to 10 years(6.5 years on average). The rates of heterotopic ossification were 5.4%(4/74) and 22.5%(18/80), respectively. There was statistically significant difference between two operative methods (Plt;0.01). Conclusion The rate of heterotopic ossification of femoral head reconstruction is lower than that of THA, so femoral head reconstruction is a better operative method for young patients and THA is suitable for old patients.
ObjectiveTo analyze the reasons and the influence of internal fixation about the guide pin eccentricity of helical blade during proximal femoral nail anti-rotation (PFNA) internal fixation for femoral intertrochanteric fractures.MethodsA retrospective analysis of the intraoperative imaging data of 175 patients with femoral intertrochanteric fractures, who underwent closed reduction and PFNA internal fixation between January 2018 and January 2020, was performed. There were 76 males and 99 females with an average age of 79.8 years (mean, 61-103 years). The internal between admission and operation was 12-141 hours (median, 32 hours). According to AO/Orthopaedic Trauma Association (AO/OTA) classification, the fractures were rated as type 31-A1 in 64 cases and type 31-A2 in 111 cases. In the intraoperative fluoroscopy image by C-arm X-ray machine, the caputcollum-diaphysis (CCD) was measured after closed reduction and internal fixation, respectively; the angles between the center line of the head nail hole and the axis of proximal nail and between the axis of guide pin and proximal nail were measured, and the difference between the two angles was evaluated; the quality of fracture reduction was evaluated according to the alignment of the medial cortex, anterior cortex of the head and neck bone block, and femoral shaft cortex; the position of the helical blade in the femoral head was evaluated according to the Cleveland method.ResultsThe CCDs of proximal femur were (134.6±6.8)° after closed reduction and (134.9±4.3)° after internal fixation. There was no significant difference between pre- and post-internal fixation (t=0.432, P=0.766). The angles between the center line of the head nail hole and the axis of proximal nail and between the axis of guide pin and proximal nail were (125.4±2.44)° and (126.3±2.3)°, respectively, showing significant difference (t=2.809, P=0.044). The difference between the two angles was (0.8±2.2)°. The guide pin eccentricity of helical blade occurred in 47 cases. After tapping the helical blade along the eccentric guide pin, 10 cases had fracture reduction loss, and 5 cases had a poor position of the helical blade in the femoral head. ConclusionDuring PFNA internal fixation, a variety of reasons can lead to the eccentric position of the guide pin of helical blade, including unstable fracture, soft tissue inserted, severe osteoporosis, mismatched tool, and fluoroscopic imaging factors. It is possible that the fracture end would be displaced again and the helical blade position may be poor when knocking into the helical blade along the eccentric guide pin. During operation, it should be judged whether the direction of the guide pin needs to be adjusted according to the eccentric angle.
Objective To evaluate the effectiveness of limited open reduction and double plates internal fixation in the treatment of Vancouver type B1 periprosthetic femoral fracture after hip arthroplasty. Methods A retrospective analysis was made on the clinical data of 12 patients with Vancouver type B1 periprosthetic femoral fracture after hip arthroplasty between May 2007 and October 2012, who underwent limited open reduction and double plates internal fixation. Of 12 patients, 4 were male and 8 were female, aged 76-85 years (mean, 81.6 years); the left side was involved in 5 patients and the right side in 7 patients. The cement prosthesis was used in 3 cases and cementless prosthesis in 9 cases; double acting head of hip arthroplasty was performed in 4 cases and total hip arthroplasty in 8 cases. The median time from first hip arthroplasty to re-fracture was 13 months (range, 5 months-5 years). The causes of injury were traffic accident in 2 cases and falling in 10 cases. Combined fractures included contralateral tibial and fibular fractures and ipsilateral distal humeral fracture (1 case), ipsilateral proximal humeral fracture (2 cases), ipsilateral distal radial fracture (1 case), and rib fracture (1 case). The time from injury to operation was 5.6 days on average (range, 3-10 days). Results The incisions all healed by first intention, and no infection or deep venous thrombosis of lower extremity occurred. Twelve cases were followed up 6-24 months (mean, 13.3 months). One female patient died of acute myocardial infarction at 16 months after operation. All the fractures were healed, with X-ray healing time of 12.5 weeks on average (range, 10-16 weeks). The time of full weight bearing was 13 weeks on average (range, 10-18 weeks). Ten cases could walk freely after operation, and 2 cases could walk by the aid of walking aid appliance. At last follow-up, the Harris score of hip function was 87.3 on average (range, 75-93). Conclusion The method of limited open reduction and double plates internal fixation for Vancouver type B1 periprosthetic femoral fracture after hip arthroplasty is effective in maintaining stability, protecting blood supply, promoting fracture healing, and doing functional exercise early. The long-term effectiveness needs further observation.
目的:總結空心螺釘、DHS或人工關節置換治療股骨頸骨折的適應證及效果。方法:分別用空心螺釘、DHS固定和人工關節置換3種方法治療獲得隨訪的中老年股骨頸骨折29例。年齡51～85歲,平均68.3歲。空心螺釘組8例,DHS組15例,人工關節組6例。結果:隨訪29例,隨訪時間1～3年,平均2~3年。圍手術期無1例死亡,無切口感染,無內固定斷裂,無關節脫位。發生退釘2例,股骨頭壞死1例。功能評定:優20例,良6例,差3例。結論:根據患者的年齡、經濟狀況、骨折部位、骨折分型合理地選擇治療方法,是減少并發癥,提高治療效果和老年人生活質量的關鍵。
ObjectiveTo explore the clinical outcome of alendronate in the treatment of bone marrow edema syndrome of the hip.MethodsA retrospective analysis of 8 cases (10 hips) of bone marrow edema syndrome of the hip treated with alendronate between December 2017 and January 2020 was conducted. Harris score and MRI exam of hip were used to assess the clinical and radiographical outcomes. Clinical cure rate and length of treatment period were used to evaluate whether alendronate was benefitial for the treatment of bone marrow edema syndrome of the hip.ResultsAll the cases were followed up for at least 3 months and got complete clinical data, the mean follow-up period was (5.2±1.2) months. Seven cases (9 hips) in 8 cases (10 hips) had clinical cure, with a clinical cure rate of 90%. The length of treatment period was 1 to 2 months with a mean value of (1.7±0.2) months. The Harris score increased from 57.8±6.3 before treatment to 98.6±1.0 at the last follow-up, and the difference was statistically significant (t=18.299, P<0.001). One case (1 hip) developed osteonecrosis of femoral head at one month after the initiation of alendronate therapy, who received continuous combination therapy of alendronate, calcium and aspirin, and no collapse or expansion of necrosis was found after 12 months follow-up.ConclusionsBone marrow edema syndrome of the hip is not a self-limiting disease completely, some patients maybe develop osteonecrosis of femoral head. Alendronate is benefitial for alleviating clinical symptom, accelerating bone edema disappearance, and shortening the course of disease.
Robot-assisted fracture reduction usually involves fixing the proximal end of the fracture and driving the distal end of the fracture to the proximal end in a planned reduction path. In order to improve the accuracy and safety of reduction surgery, it is necessary to know the changing rule of muscle force and reduction force during reduction. Fracture reduction force was analyzed based on the muscle force of femoral. In this paper, a femoral skeletal muscle model named as PA-MTM was presented based on the four elements of skeletal muscle model. With this, pinnate angle of the skeletal muscle was considered, which had an effect on muscle force properties. Here, the muscle force of skeletal muscles in different muscle models was compared and analyzed. The muscle force and the change of the reduction force under different reduction paths were compared and simulated. The results showed that the greater the pinnate angle was, the greater the influence of muscle strength was. The biceps femoris short head played a major role in the femoral fracture reduction; the force in the z direction contributed the majority to the resulting force with maximums of 472.18 N and 497.28 N for z and resultant, respectively, and the rationality of the new musculoskeletal model was verified.
Objective To study the effect of simultaneous bilateral total hip arthroplasty in a single procedure. Methods From October 1999 to March 2004, 15 patients (30 hips) underwent simultaneous sequential bilateral total hip arthroplasty (THAs) in a single procedure. Of the 15 patients, 11 were male (22 hips) and 4 were female (8 hips). Their ages ranged from 35 to 70 years. Their courses of disease ranged from 1 year to 50 years (4.8 years on average). The Harris scores of the joint function before the operation ranged from 12 to 45 points (27 points on average). Five were done with Smith-Peterson and 10 were done with Moore. Results The operative time was 3 hours and 25 minutes to 5 hours (4 hours and 10 minutes on average). The volume of blood transfusion during operation was 400 to 2 400 ml (1 160 mlon average). All the 15 patients were followed up for 3 to 35 months (18 monthson average). The Harris scores of the joint function after the operation rangedfrom 70 to 100 points (86 points on average). There was significant difference in the scores between before and after operations (Plt;0.05). There was only 1death within 1 months of the operation and no serious between complications such as infection, pulmonary embolism, and deep vein plug. All the patients were still ambulant in the community and gained significant pain relief. Conclusion Simultaneous bilateral total hip arthroplasty in a single procedure is a safe and effective method. However, the decision of performing singlestage bilateral total hip arthroplasty should be carefully made and preoperative preparation should be sufficiently made.