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.	劉蘇, 田守進, 倪善軍. DHS加空心釘治療不穩定股骨粗隆間骨折分析. 實用骨科雜志, 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.	鄭得志, 于建華, 楊有庚, 等. 股骨轉子間骨折動力髖螺釘內固定失敗的危險因素. 中華創傷雜志, 2006, 22(2):129-132.
5.	秦暉, 安智全. InterTan治療股骨粗隆間骨折的療效評估. 中國修復重建外科雜志, 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.	譚三智, 黃桂填. DHS和PFN治療股骨粗隆間骨折的療效分析. 實用醫學雜志, 2010, 26(18):3395-3396.
8.	Canale ST, Beaty JH. 坎貝爾骨科手術學. 王巖, 譯. 11版. 北京:人民軍醫出版社, 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.	Kr?pfl 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.	Kr?pfl 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.	郭曉澤, 章瑩, 肖進. 動力髖螺釘固定股骨轉子間骨折的有限元分析. 臨床骨科雜志, 2012, 15(4):458-461.
18.	徐莘香, 劉一, 李長勝, 等. 當前骨折內固定治療中的幾個基本問題. 中華骨科雜志, 1996, 16 (4):204-207.
19.	李鵬, 賈玉華, 等. 股骨小轉子復位器的研制與臨床應用. 中國矯形外科雜志, 2010, 18(23):2013-2014.

1. 劉蘇, 田守進, 倪善軍. DHS加空心釘治療不穩定股骨粗隆間骨折分析. 實用骨科雜志, 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. 鄭得志, 于建華, 楊有庚, 等. 股骨轉子間骨折動力髖螺釘內固定失敗的危險因素. 中華創傷雜志, 2006, 22(2):129-132.
5. 秦暉, 安智全. InterTan治療股骨粗隆間骨折的療效評估. 中國修復重建外科雜志, 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. 譚三智, 黃桂填. DHS和PFN治療股骨粗隆間骨折的療效分析. 實用醫學雜志, 2010, 26(18):3395-3396.
8. Canale ST, Beaty JH. 坎貝爾骨科手術學. 王巖, 譯. 11版. 北京:人民軍醫出版社, 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. Kr?pfl 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. Kr?pfl 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. 郭曉澤, 章瑩, 肖進. 動力髖螺釘固定股骨轉子間骨折的有限元分析. 臨床骨科雜志, 2012, 15(4):458-461.
18. 徐莘香, 劉一, 李長勝, 等. 當前骨折內固定治療中的幾個基本問題. 中華骨科雜志, 1996, 16 (4):204-207.
19. 李鵬, 賈玉華, 等. 股骨小轉子復位器的研制與臨床應用. 中國矯形外科雜志, 2010, 18(23):2013-2014.

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