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A Comparaitve Study of the Clinic Effects in the Treatment of Senile Femoral Intertrochanteric Fracture with Three Internal Fixation Methods

Author: SangChengLin
Tutor: CaoXueCheng
School: Second Military Medical University
Course: Surgery
Keywords: Femoral intertrochanteric fracture Internal fixations Locking plate DHS Gamma nail
CLC: R687.3
Type: Master's thesis
Year: 2012
Downloads: 82
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Abstract


ObjectiveTo compare the effects of DHS (Dynamic Hip Screw),the Proximal Femoral LockingPlate and the Gamma Nail in the treatment of senile femoral intertrochanteric fracture andto provide reference for choosing the proper method for intertrochanteric fractures andfuture research.MethodThe researcher chose his research object from the patients treated in Department ofOrthopaedics Jinan Military Ceneral Hospital for femoral intertrochanteric fracture. Thesepatients were all aged between60and85. They were treated with the following threemethods respectively: Proximal Femoral Locking Plate, DHS (Dynamic Hip Screw) andthe Gamma Nail. Here, their femoral intertrochanteric fracture was caused by injury.Pathologic fracture was excluded. The patients chosen for the study were and recorded.Through their medical records, telephone follow-up, their recheck record, home follow-upto cases of special importance and so on and with the ones out of the follow-up beingexcluded,224patients were included in the final comparison. They were divided into threedifferent groups according to their treatment method.ResultsStatistic analysis between any two of the three groups in terms of the average blood lossduring the operation is of statistical significance.(p<0.05): the Proximal Femoral LockingPlate group was of the maximum blood loss and the Gamma Nail group was of theminimal blood loss. The data for DHS group was in between. Statistic analysis betweenany two of the three groups in terms of the average operation time was of no statisticalsignificance.(p>0.05) Statistic analysis of the three groups in terms of the Sander’s scoreand Harris hip score was of no statistical significance.(p>0.05) Conclusions1. There is no obvious difference in terms of long term clinical effects among the threetherapeutic methods. The patients in the Gamma Nail group could walk withweight-bearing relatively earlier, had a lower incidence rate of complications during thepatients’ hospitalization and enjoyed better clinical effects than those in the ProximalFemoral Locking Plate group and DHS group.2. As for A1Stable Fracture, the incidence rates of complications of the three groupswere more or less the same. Thus, all the three internal fixations can be the method ofchoice. However, as for the A2Unstable Fracture and A3Unstable Fracture, the incidencerates of complications of the Proximal Femoral Locking Plate group and the DHS groupwere significantly higher than that of the Gamma Nail group. Thus, Gamma Nail should bethe method of choice.3. The operation time of the three groups was more or less the same. However, theGamma nail method which features less blood loss and lower incidence rate ofintraoperative and postoperative complications, and provides stable fixation for all types offractures is a reasonable surgical method, especially for the A2and A3femoralintertrochanteric fracture with osteoporosis.

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CLC: > Medicine, health > Surgery > Orthopaedic Surgery ( movement system diseases,orthopedic surgery ) > Orthopedic surgery and surgery > Bone surgery
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