Double-head compression screw internal fixation for the treatment of femoral neck fracture in middle-aged and elderly patients
Double-head compression screw internal fixation for the treatment of femoral neck fractures in middle-aged and elderly patients Cai Hongqing, Wang Hongtao, Li Haijun, Huo Xiwu (Department of Orthopaedics, Heilongjiang Second People's Hospital, Heilongjiang Helen 15230 (1) method under the X-ray monitoring, accurate alignment, small incision, small damage, internal It is firmly fixed and has a pressurizing effect to promote the healing of the fracture end. Full preoperative preparation, intraoperative and postoperative cardiac and brain function monitoring, and reasonable training are the key steps to reduce the complication of femoral neck fracture in the elderly.
Femoral neck fractures often occur in middle-aged and elderly people, and their incidence is increasing as their life expectancy increases. In clinical treatment, fracture nonunion and avascular necrosis of the femoral head remain a problem. In order to reduce the pain caused by femoral neck fracture in middle-aged and elderly people, promote the early healing of fractures, reduce the necrosis rate of the femoral head, prevent the occurrence of complications, restore the function of the limbs and self-care ability. Internal fixation is an important treatment. From 1990 to 2001, our hospital used two double-head compression screws for the treatment of 78 cases of middle-aged and elderly femoral neck fractures, and received good results. It is summarized as follows.
1 General information Among 78 cases, 45 males and 33 females. The youngest is 43 years old and the oldest is 84 years old. Among them, 11 cases were sub-type, 42 cases were middle-neck, and 25 cases were basal. There were 42 cases of common diseases such as heart disease, hypertension, cerebrovascular disease and respiratory diseases.
2 treatment methods after the femoral neck fracture, the general use of rapid traction reduction method, according to different types of fractures to take the reset method. That is: under X-ray or TV X-ray monitoring, two assistants are used to resist traction, and the affected limb is pulled by abduction 30* internal rotation 30*, or reset by a quick resetter. The fracture alignment was observed under the X-ray. After satisfactory, carry out routine disinfection, spread the sterile towel, cut a small incision about 10~5cm under the femur of the affected limb, and cut the skin, subcutaneous tissue, fascia, periosteum, and adjust the X-ray. 1 angle of the nail. Generally, according to the angle of the neck angle of the femoral neck and the angle of the anteversion, the 5mm drill bit is used to close the femur to drill the 1 hole, and the 1 guide pin is used to probe the 4 wall to ensure that the hole is drilled in the femur, and the guide pin is screwed into a 55mm. Hollow double head compression screw. Directly to the lower part of the femoral head 0.5~1cm, this needle plays the role of support and weight. Then drill the second hole 2cm away from the upper end of the first nail and screw in the second compression nail. This one mainly serves to prevent the head from rotating and to strengthen the internal fixation. After screwing in, do not suture temporarily, and cover the X-ray positive lateral femoral neck image after covering with sterile dressing. Observe the position, angle and depth of the two nails. If you are not satisfied, remove the nail and then adjust it. After satisfaction, the saline is rinsed and sutured, and the operation is over.
Results In the 5-year follow-up, in 78 cases, the fracture healed and the hip function returned to normal. 45 cases were able to live and work normally, accounting for 57.7%. The fracture was healed, the hip function was slightly restricted, and walking was required to help. There is mild pain in walking. There is no 2 method to check the CT machine for Toshiba Xision/GX spiral CT machine. The scanning time is 1 s layer thickness is 5mm, the layer spacing is 5mm, the voltage is 120kV, and the current is 150mA/s. The scanning range is From the base of the skull to the lower edge of the third cervical vertebrae, the transverse section is swept flat, and individual cases are scanned for cross-sectional enhancement.
3 Results 35 patients with nasopharyngeal carcinoma had bilateral asymmetry of the nasopharyngeal cavity, 20 patients with shallow crypt crypt, 15 patients with pharyngeal recess disappearance, 25 patients with thickened pharyngeal wall and increased density, and posterior pharyngeal wall. 21 cases were thickened and increased in density, 9 cases had enlarged cervical lymph nodes, the fat space between the pharyngeal muscles disappeared, 35 cases had structural disorder, 35 cases had local soft tissue density mass, and 28 cases had parapharyngeal fat gap shift. . Enhanced scanning of local soft tissue masses with mild enhancement.
10 patients with nasopharyngitis also saw asymmetry on both sides of the nasopharyngeal cavity, shallow or disappeared pharyngeal crypt, thickening of the soft tissue of the pharyngeal wall and / or posterior wall (but no significant increase in density) increased fat density between the pharyngeal muscles (But the shape of each muscle in the pharynx is still distinguishable) The parapharyngeal space is only slightly displaced outward. In 2 cases, several small bubbles are visible in the bottom and side walls of the pharyngeal crypt, which enhances the display of the nasopharynx structure. The tissue is slightly strengthened, the fat gap and the exudate are not strengthened) and it is normal.
4 Discussion The most common primary site of nasopharyngeal carcinoma is the pharyngeal recess. Early CT signs are shallow or disappeared of the pharyngeal crypt, bilateral asymmetry of the pharyngeal cavity, thickening of the pharyngeal side wall and / or posterior wall, increased density, disappearance of intermuscular fat space, unclear structure, enhanced scanning structure remains necrotic Phenomenon, 23 cases of self-care, accounting for 29 1%; femoral neck non-healing within 12 months, 7 cases of necrosis of femoral head within 3 years, accounting for 12 2%, of which 2 cases did not reach bone healing and died in other Diseased.
4 Discussion 1 middle and old aged femoral neck fracture, internal fixation is the best treatment. There are many types of internal fixations, and it is very important to use which fixation method. We use a 5mm2 double-head compression screw for internal fixation, which can firmly fix the broken end, prevent the rotation of the femoral head, pressurize the broken end, the nail is straight and thin, and the damage to the bone destruction is small, which promotes the fracture. The healing of the femoral neck and the rate of necrosis of the head decreased significantly.
42 Due to the decline in physical fitness of middle-aged and elderly people, a series of complications often occur after trauma. Long-term bed rest can lead to many complications. Therefore, early surgery, restore function as soon as possible, and strive for work and self-care. Therefore, we used early rapid reduction, small incision, X-ray monitoring and internal fixation received good results.
43 adequate preoperative preparation, intraoperative and postoperative cardiopulmonary monitoring, postoperative care and reasonable training are also key steps in treatment.
44 Reasonable use of antibiotics after surgery to encourage patients to sputum and prevent pneumonia. Let the patient sit up as early as possible to prevent venous thrombosis and joint stiffness. Itâ€™s early to practice in bed, and itâ€™s important to get out of bed. And pay attention to the patient's mentality and mood, patient care, so that patients increase confidence in the fight against disease.
The angle of the needle is very important. It must be done according to the neck angle and the anteversion angle of the femoral head. The first nail is best screwed in along the femur, which is firm and reliable. X-ray filming should be performed during the operation to determine the angle and position of the nail. Do not screw it outside the femoral neck cortex.
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