DESIGN AND CLINICAL APPLICATION OF LESSER TROCHANTERIC REDUCTION FIXATION SYSTEM_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

GUOXiaoze ,  ZHANGYing , XIAOJin , XIEHuibin , YUJiefeng

Department of Orthopaedic Trauma, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou Guangdong, 510010, P. R. China;

Corresponding author：

ZHANGYing, Email: zhangying_doc@aliyun.com

Keywords：

Lesser trochanteric reduction fixation system; Intertrochanteric fracture; Dynamic hip screw; Internal fixation

DOI：

10.7507/1002-1892.20150028

Video：

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ObjectiveTo design and produce a lesser trochanteric reduction fixation system and verify its value and effectiveness. MethodsA lesser trochanteric reduction fixation system was designed and produced according to the anatomical features of the lesser trochanteric fractures. Sixty-six patients with intertrochanteric fractures of Evans type Ⅲ were included between January 2010 and July 2012. Of 66 patients, 32 were treated with dynamic hip screw (DHS) assisted with the lesser trochanteric reduction fixation system (study group), and 34 cases were treated with DHS only (control group). The 2 groups were comparable with no significant difference in gender, age, the reasons, and the types of the fractures (P>0.05). The operation time, intraoperative blood loss, neck-shaft angle, bone healing time, ratio of successful fixations, and the functional evaluation of the hip joint after operation were compared between 2 groups. ResultsThe study group had shorter operation time [(58.4±5.3) minutes] and less intraoperative blood loss [(186.3±6.6) mL] than the control group[(78.5±6.2)minutes and (246.2±8.7) mL], showing significant differences (t=-14.040, P=0.000; t=-31.145, P=0.000). There was no significant difference in neck-shaft angle between study group [(138.6±3.0)°] and control group [(139.4±2.9)°] (t=-1.044, P=0.301). The wounds healed by first intention in both groups. The 30 and 31 patients were followed up 12 to 24 months (mean, 15 months) in the study group, and 13 to 25 months (mean, 16 months) in the control group, respectively. All fractures healed well in 2 groups. The study group had significantly shorter healing time [(8.8±2.0) weeks] than the control group [(10.7±3.4) weeks] (t=-2.871, P=0.006). At 12 months after operation, coxa vara happened in 2 cases of the study group with a successful fixation ratio of 93.3% and in 10 cases of the control group with a successful fixation ratio of 67.7%, showing significant difference (χ²=6.319, P=0.022). According to Harris hip score, the excellent and good rate was 83.3% in the study group (25/30) and was 58.1% in the control group (18/31), showing significant difference (χ²=4.680, P=0.049). ConclusionThe application of the lesser trochanteric reduction fixation system can reduce stripping of the soft tissue around the fracture fragments, shorten the operation time and the healing time, and preserve the function of the hip joint maximumly.

Citation： GUOXiaoze, ZHANGYing, XIAOJin, XIEHuibin, YUJiefeng. DESIGN AND CLINICAL APPLICATION OF LESSER TROCHANTERIC REDUCTION FIXATION SYSTEM. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(2): 133-137. doi: 10.7507/1002-1892.20150028 Copy

1.	刘苏, 田守进, 倪善军. DHS加空心钉治疗不稳定股骨粗隆间骨折分析. 实用骨科杂志, 2008, 14(7):429-431.
2.	Alobaid A, Harvey EJ, Elder GM, et al. Minimally invasive dynamic hip screw:prospective randomized trial of two technique of insertion of a standard dynamic fixation device. J Orthop Trauma, 2004, 18(4):207-212.
3.	Christodoulou NA, Sdrenias CV. External fixation of select intertrochanteric fractures with single hip screw. Clin Orthop Relat Res, 2000, (381):204-211.
4.	郑得志, 于建华, 杨有庚, 等. 股骨转子间骨折动力髋螺钉内固定失败的危险因素. 中华创伤杂志, 2006, 22(2):129-132.
5.	秦晖, 安智全. InterTan治疗股骨粗隆间骨折的疗效评估. 中国修复重建外科杂志, 2010, 24(12):1424-1427.
6.	Peleg E, Mosheif R, Liebergall M, et al. A short plate compression screw with diagonal bolts-a biomechanical evaluation performed experimentally and by numerical computation. Clin Biomech (Bristol, Avon), 2006, 21(9):963-968.
7.	谭三智, 黄桂填. DHS和PFN治疗股骨粗隆间骨折的疗效分析. 实用医学杂志, 2010, 26(18):3395-3396.
8.	Canale ST, Beaty JH. 坎贝尔骨科手术学. 王岩, 译. 11版. 北京:人民军医出版社, 2009:2538-2539.
9.	Xu YZ, Geng DC, Mao HQ, et al. A comparison of the proximal femoral nail antirotation device and dynamic hip screw in the treatment of unstable pertrochanteric fracture. J Int Med Res, 2010, 38(4):1266-1275.
10.	Smith GH, Tsang J, Molyneux SG, et al. The hidden blood loss after hip fracture. Injury, 2011, 42(2):133-135.
11.	Sehat KR, Evans RL, Newman JH. Hidden blood loss following hip and knee arthroplasty. Correct management of blood loss should take hidden loss into account. J Bone Joint Surg (Br), 2004, 86(4):561-565.
12.	Kröpfl A, Berger U, Neureiter H, et al. Intramedullary pressure and bone marrow fat intravasation in unreamed femoral nailing. J Trauma, 1997, 42(5):946-954.
13.	Kröpfl A, Davies J, Berger U, et al. Intramedullary pressure and bone marrow fat extravasation in reamed and unreamed femoral nailing. J Orthop Res, 1999, 17(2):261-268.
14.	Whitenack SH, Hausberger FX. Intravasation of fat from the bone marrow cavity. Am J Pathol, 1971, 65(2):335-345.
15.	Dimeski G, Mollee P, Carter A. Increased lipid concentration is associated with increased hemolysis. Clin Chem, 2005, 51(12):2425.
16.	Cooper RA. Abnormalities of cell-membrane fluidity in the pathogenesis of disease. N Engl J Med, 1977, 297(7):371-377.
17.	郭晓泽, 章莹, 肖进. 动力髋螺钉固定股骨转子间骨折的有限元分析. 临床骨科杂志, 2012, 15(4):458-461.
18.	徐莘香, 刘一, 李长胜, 等. 当前骨折内固定治疗中的几个基本问题. 中华骨科杂志, 1996, 16 (4):204-207.
19.	李鹏, 贾玉华, 等. 股骨小转子复位器的研制与临床应用. 中国矫形外科杂志, 2010, 18(23):2013-2014.

1. 刘苏, 田守进, 倪善军. DHS加空心钉治疗不稳定股骨粗隆间骨折分析. 实用骨科杂志, 2008, 14(7):429-431.
2. Alobaid A, Harvey EJ, Elder GM, et al. Minimally invasive dynamic hip screw:prospective randomized trial of two technique of insertion of a standard dynamic fixation device. J Orthop Trauma, 2004, 18(4):207-212.
3. Christodoulou NA, Sdrenias CV. External fixation of select intertrochanteric fractures with single hip screw. Clin Orthop Relat Res, 2000, (381):204-211.
4. 郑得志, 于建华, 杨有庚, 等. 股骨转子间骨折动力髋螺钉内固定失败的危险因素. 中华创伤杂志, 2006, 22(2):129-132.
5. 秦晖, 安智全. InterTan治疗股骨粗隆间骨折的疗效评估. 中国修复重建外科杂志, 2010, 24(12):1424-1427.
6. Peleg E, Mosheif R, Liebergall M, et al. A short plate compression screw with diagonal bolts-a biomechanical evaluation performed experimentally and by numerical computation. Clin Biomech (Bristol, Avon), 2006, 21(9):963-968.
7. 谭三智, 黄桂填. DHS和PFN治疗股骨粗隆间骨折的疗效分析. 实用医学杂志, 2010, 26(18):3395-3396.
8. Canale ST, Beaty JH. 坎贝尔骨科手术学. 王岩, 译. 11版. 北京:人民军医出版社, 2009:2538-2539.
9. Xu YZ, Geng DC, Mao HQ, et al. A comparison of the proximal femoral nail antirotation device and dynamic hip screw in the treatment of unstable pertrochanteric fracture. J Int Med Res, 2010, 38(4):1266-1275.
10. Smith GH, Tsang J, Molyneux SG, et al. The hidden blood loss after hip fracture. Injury, 2011, 42(2):133-135.
11. Sehat KR, Evans RL, Newman JH. Hidden blood loss following hip and knee arthroplasty. Correct management of blood loss should take hidden loss into account. J Bone Joint Surg (Br), 2004, 86(4):561-565.
12. Kröpfl A, Berger U, Neureiter H, et al. Intramedullary pressure and bone marrow fat intravasation in unreamed femoral nailing. J Trauma, 1997, 42(5):946-954.
13. Kröpfl A, Davies J, Berger U, et al. Intramedullary pressure and bone marrow fat extravasation in reamed and unreamed femoral nailing. J Orthop Res, 1999, 17(2):261-268.
14. Whitenack SH, Hausberger FX. Intravasation of fat from the bone marrow cavity. Am J Pathol, 1971, 65(2):335-345.
15. Dimeski G, Mollee P, Carter A. Increased lipid concentration is associated with increased hemolysis. Clin Chem, 2005, 51(12):2425.
16. Cooper RA. Abnormalities of cell-membrane fluidity in the pathogenesis of disease. N Engl J Med, 1977, 297(7):371-377.
17. 郭晓泽, 章莹, 肖进. 动力髋螺钉固定股骨转子间骨折的有限元分析. 临床骨科杂志, 2012, 15(4):458-461.
18. 徐莘香, 刘一, 李长胜, 等. 当前骨折内固定治疗中的几个基本问题. 中华骨科杂志, 1996, 16 (4):204-207.
19. 李鹏, 贾玉华, 等. 股骨小转子复位器的研制与临床应用. 中国矫形外科杂志, 2010, 18(23):2013-2014.

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