Treatment of femoral neck and intertrochanteric fracture with double-head hollow compression screw in Fufeng County People's Hospital of Shaanxi Province (722200) Zhang Xianliang Therapeutic effect of femoral neck and intertrochanteric fracture in the treatment of fracture fixation with cannulated compression screw 2000, the author used bed The head was inserted into the needle and the small incision was screwed into the Jiyang brand double-head hollow compression screw to treat 52 cases of middle-aged femoral neck and intertrochanteric fractures. The satisfactory results are as follows: 1 clinical data for 4 days, femoral neck fracture 27 cases, 9 males and 18 females; the youngest was 45 years old, the largest was 82 years old; 19 cases were fall sitting injury, 6 cases were fall from height, 2 cases were other injuries; 1 case of Garden type 1 type 5 cases, 11 cases, 111 There were 8 cases of 8 cases of JV type; 3 cases of hypertension, 6 cases of pulmonary heart disease, and 2 cases of diabetes. There were 25 cases of intertrochanteric fractures, including 13 males and 12 females; the youngest was 46 years old and the largest was 78 years old; 12 cases were fall sitting injury, 10 cases were fall from height, 3 cases were injured by other reasons; Evan's type 1 type 7 For example, there were 12 cases of type A and 6 cases of type A; 3 cases of hypertension, 4 cases of pulmonary heart disease, and 1 case of diabetes.
2 treatment 2.1 reduction methods were used for tibial tuberosity traction, weight for weight 1 / 7 ~ 1/10 traction 3 days after taking the bed X-ray film, observe the fracture alignment. If the alignment is poor, you can adjust the traction weight, posture or use the orthopedic technique to obtain an accurate and accurate reduction of the inserted fracture or good alignment. Use small weight traction to maintain the contra-position 2.2-guide needle-in method to mark the hip with purple medicine. The projection position of the femoral head surface and the longitudinal axis of the lateral surface of the femoral shaft. On this line, 4 points are drawn at the lower edge of the greater trochanter at 0. 5152.55 cm as the position of the needle of the four Kirschner wires (guide needle), with iodine After the local anesthesia is disinfected, the 2.5mm Kirschner wire is inserted into the skin from the marked points to the periosteum. Before drilling into the bone, the center point of the femur is firstly swept from the front and back of the needle tip. The 12th Kirschner wire was 0.5cm from the center of the center, and the Kirschner wire and the outer edge of the femur were kept at an angle of about 60*; the 34th Kirschner needle was 0.5cm away from the center of the needle, and the outside of the femur There is a 40* angle between the angles of the person to pay attention to the anteversion angle, pay attention to the patient's reaction, if the sudden pain is aggravated, the Kirschner wire is mostly empty, and the direction must be re-adjusted. X-ray films were taken after surgery to observe the position of the Kirschner wire.
3 guide pin selection of femoral neck fractures from the 12th Kirschner wire and the 3rd and 4th K-wire each selected the best position for the guide intertrochanteric fracture only select the 34th Kirschner wire for The guide needle, the 12th Kirschner wire is only temporarily fixed. 2.4 Double-headed hollow compression screw fixed the head of the Kirschner needle and the patient is transferred to the operating room. Conventional disinfection, toweling. Only local anesthesia was performed on the two Kirschner wires that had been selected for the guide needle, and the skin was cut 1.5 cm directly to the periosteum. Use a cortical bone opener or a small goose eyebrow to cut a part of the cortical bone, let the screw fit into the guide pin, and screw the X-ray film after screwing in the screw. The screw tip is 0.5-1cm under the cartilage surface of the femoral head. . The guide needle and the remaining Kirschner wire were removed, the skin was sutured, and the skin was aseptically bandaged. The results of routine anti-inflammatory treatment after treatment were followed up for 49 cases. The follow-up time was as short as 1 year and the longest was 4 years. According to pain, joint function, fracture healing and complete recovery of hip varus and femoral head necrosis, 9 cases without hip varus and femoral head necrosis, fracture healing, occasional pain, joint function recovery 70%, femoral neck Shortened, the neck dry angle is slightly smaller, but there is no hip varus and femoral head necrosis in 2 cases, all of which are GareldV type of femoral neck fracture, 1 case of fracture is not healed, 1 case of femoral head necrosis and 1 case of femoral head necrosis after fracture healing 1/4, walking pain, lameness, life can take care of this group, there is no internal fixation loosening, fracture, prolapse and postoperative infection. 4 Discussion 4.1 Choice of indications Femoral neck fractures and intertrochanteric fractures have more treatment methods, each with its own advantages Disadvantages To get the best results, the choice of indications is critical. This method is only applicable to: 1), 1 type, 1 U1A type intertrochanteric fracture of fresh femoral neck fracture and Evans classification in 1Garden classification. 2 Traction or manipulation can make the fracture reach or close to the anatomical position. 3 pairs of freshly crushed or old femoral neck fractures and Evans classification 1BV type intertrochanteric fractures are not suitable 4.2 The significance of the choice of guide needle changes with this method for the treatment of femoral neck fractures and intertrochanteric fractures, the choice of guide needles to meet the hip joint Biomechanical properties. The femoral neck internal tension trabecular system and the pressure trabecular system are located in the anterior and posterior femoral neck, respectively. Therefore, the 12th and 3rd and 4th Kirschner needle insertion points should be located slightly before and after the femoral center. In this way, it can ensure that the Kirschner wire (guide needle) does not deviate in the tension and pressure bone beam system, and also can screw the double-headed hollow compression screw in the trabecular bone with good holding force. The two guide needles selected for the femoral neck fracture have an angle of about 60*å©40* with the femoral shaft, which allows the double-ended cannulated screw to be screwed into the femoral neck space 0.5cm below the femoral head. A triangular truss function; intertrochanteric fracture, because the 12th Kirschner wire is close to the trochanter, where the cortical bone is thin, close to the fracture line, the Kirschner wire support force point is weak, the arm is short, which will greatly weaken the internal fixation screw Stability, so only temporary fixation, and the 34th Kirschner wire, cortical bone thick, and close to the femur distance, use them as a guide pin screwed into the double-head hollow compression nail, its tensile strength and shear The strength is higher.
4.3 Advantages of two double-headed hollow compression screws The double-headed hollow compression screws are made of 317L steel, which can carry high-strength load and bending moment, and also have self-tapping ability. The front part is a coarse bone of cancellous bone, the middle part is smooth, and the back part is a conical body with fine threads of cortical bone. Since both ends of the fracture are screwed, the progress of the thread before and after the screwing is different, and the conical body at the tail can generate axial pressure at the fracture end, so that the fracture surface is in close contact, and even the shear force at the fracture end is reduced. The compressive stress and the two double-headed hollow compression screws are combined and fixed, which also increases the anti-rotational force [3], further increases the internal fixation and stability of the iliac crest, and there is intermittent physiological stress between the fracture end faces. [4] All of the above are beneficial to improve the fracture healing rate.
4.4 postoperative functional exercise problems The perfect surgery is only half of the success, the other half is the correct postoperative treatment and patient cooperation. Regardless of femoral neck fracture or intertrochanteric fracture, within 3 weeks after surgery, active ankle joint active exercise and ipsilateral knee and hip joint flexion and extension activities can only be performed in bed. After 3 weeks, the affected limbs did not carry heavy weight. Within 8 weeks, the hip can not be adducted, abducted, and rotated inside and outside. Only for flexion and extension exercises, the affected limb is partially loaded. After the fracture is healed, the patient will be assisted for one to four months to promote fracture healing and avoid hip varus and femoral head necrosis. Case fracture J healing without pain (suitable Tc function lisAg
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