Treatment of intertrochanteric fractures of the femur with Richards hip compression screws (Report of 73 cases)

4 Li she, Chen Nan, Liu Zhangsuo. Blood lipids and renal interstitial fibrosis. Foreign medical internal medicine points 5 Li Xiujun, Qian Rongli. Insulin resistance and its clinical significance. Chinese Journal of Diabetes, Richards hip compression screw for intertrochanteric fractures (Report of 73 cases) Department of Orthopaedics, Jiangyan People's Hospital, Jiangsu Province (225500) Liu Yulin, Wang Xixi, Wang Huanan, Wang Wei, Chen Weimin, Richards hip compression screw for intertrochanteric fractures Cases (age 52 to 81 years old) There were two or more comorbidities in this group. Twenty-three (35%) comorbidities were mainly cardiovascular diseases, followed by diabetes. Eighty-five patients in this group were followed up for an average of 21 months. Results: Excellent 76%, good 18%. Postoperative complications in 9 cases (12.3%) Conclusion: The authors believe that the application of Richards nail treatment has early bed-out, less complications, low mortality, and most patients recover their self-care ability. It is a good internal fixation nail for the treatment of intertrochanteric fractures.

Femoral intertrochanteric fractures are common in the elderly. The traditional method is mainly non-surgical treatment. This method has long braking time, many complications, high mortality rate, and high incidence of hip varus deformity. Therefore, orthopedic surgeons are increasingly advocating Active surgical treatment. Among the patients with intertrochanteric fractures admitted between 1995 and 2001, 73 patients underwent Richards internal fixation and achieved satisfactory results. The report is as follows: 1 General information: 73 patients in this group, aged 52-81 years old, The average is 692 years old. There were 21 males and 52 females. According to Evans classification, 1*14 cases, 2*36 cases, 3*20 cases, 42 cases, 1 case type 1 case. About 77.9% of patients with medical diseases, including coronary heart disease, hypertension, arrhythmia, conduction block, cerebral vascular insufficiency, chronic bronchitis, old tuberculosis, diabetes, deep vein thrombosis, etc. The above medical diseases were 23 cases, accounting for 35%. 2 Treatment methods: This group of patients underwent tibial tuberosity traction for 5 to 10 days after admission, during which preoperative examination and preparation, including treatment of medical complications. The blood pressure of hypertensive patients is controlled below 20~22kPa/11~12kPa, and the blood glucose control of diabetic patients is below 80mmo/L. The operation was performed under the supervision of C-arm X-ray machine. The hip bolster was involved. The type 1* and 2* patients were not traction-reset. The remaining cases were extended, abducted, and the internal rotation was reset and properly fixed. The left lateral femoral incision was taken to cut off the lateral femoral muscles and retracted upward. The angler assists in the placement of the guide pin, and the C-arm confirms the position, depth sounding, and combined reamer opening. The 13" or 140* 4~8 hole Richards nail is used. Type 1 3°, 4° and type 1 patients, depending on the situation, use screws and steel wire to assist in fixation. After the operation, the muscles and joints were active, and the patients were sitting 3 to 5 days after the operation. The stable fractures were carried out without weight-bearing for 4 weeks after the operation, and the weight was lost. The unstable type was 6-8 weeks after the operation. 13 Results: Patients in this group The patients were followed up for 4 months to 5 years, with an average of 21 months. The average clinical healing time was 3.8 months. According to clinical healing criteria: excellent: fracture healing, hip no pain, hip activity similar to pre-injury; good: fracture healing, occasional hip pain, hip joint activity slightly worse than pre-injury; middle: fracture healing, mild In the hip, the hip joint activity is limited, there is hip pain; poor: fracture deformity healed or not healed, often feel hip pain, can not get out of bed weight-bearing walking, this group of excellent 55 cases, good 13 cases, 5 cases . There were 3 cases of pulmonary infection, 1 case of cerebral thrombosis, deep venous blood and fracture, loosening and prolapse. There was no postoperative hemorrhoids, no surgery and perioperative death, and the postoperative complication rate was about 123%. 2.1 Intertrochanteric fractures are common fractures in the elderly. Because of this osteoporosis, the femoral head and neck are stressed. A large bending moment is formed between the rotors, and the medial and lateral bony support of type 1 3°, 4° and type 1 fractures is destroyed, the conservative treatment effect is poor, and the mortality is high. Lu Ying reported 203 cases of non-surgical group mortality rate of 3.6%, surgery group 0.8%12, Xu Jigang reported 438 cases, traction group mortality rate of 6.1%, surgery group 0.9%|3), Western countries almost no conservative treatment | 4L this group Richards nail fixation, no intraoperative and perioperative death, excellent rate of 92. 2 surgical treatment of intertrochanteric fractures of internal fixation equipment, doctors should fully estimate the patient's surgery and internal fixation before the operation Tolerance of treatment, as secure as possible, less trauma, shortened operation time, early functional exercise and bed-out activities, as far as possible to achieve self-care, reduce complications and improve quality of life. 15.Richards nail is a kind of telescopic internal fixation The device allows the proximal end of the fracture to telescope on the fixture to find its own stable position while the backbone is displaced inward. In elderly patients, the fractures are smaller and the osteoporosis is more obvious. The Richards nail can maintain the axial compression of the fracture. Although the limb may have a certain degree of shortening, it increases the stability and also provides the possibility of early functional exercise. The Richards nail is an ideal internal fixation.

3 In the treatment of Richards nail fixation, the following problems should be noted: 1 should be taken before the normal side of the hip joint piece to help determine the neck angle of the required nail plate, according to the fracture piece to determine the required Richards nail Length; 2, as far as possible before surgery, the fracture technique should be reset, pay attention to the contact between the medial and posterior cortical bones, preset anteversion angle; 3 compression screw placed in the center of the femoral head neck or slightly lower back, the front upper part is bone The worst part. The tip of the screw is 5~10mm away from the subchondral bone; 4The comminuted fracture is far backward of the fracture end, and the closed reduction is difficult to achieve satisfactory results. The open reduction should be considered. In rare cases, non-anatomical methods should not be taken, such as the fracture segment. Move inside to find the stability after fixing. Surgery that can neither dissect the anatomy nor stabilize the reset is a failure; *After the installation of the Richards nail, the position should be confirmed by the C-arm machine or the camera and the hip should be activated to prevent the formation of the plug. Unexpectedly, the running plate was used to penetrate the femoral head. In this group, there is a perspective pressure screw that is not close to the subchondral bone. The hip is found to have limited activity after suturing the skin. The horizontal perspective shows that the compression screw has penetrated into the joint cavity and has to reopen the incision. Replace the compression screw. Although postoperative functional recovery is acceptable, it is unknown whether it will cause long-term complications. It should be cited as a profound lesson; 6 osteoporosis is obvious, advanced age and serious medical problems, can not tolerate anesthesia or surgery Trauma patients should be a relative contraindication to Richards nail fixation.

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