BACKGROUND:Undergoing femoral head replacement in senile osteoporosis patients with intertrochanteric fracture is a chal enging problem.
OBJECTIVE:To explore the clinical effect of the use of joint instal ation and fracture reduction on the treatment of unstable intertrochanteric fractures in elderly patients.
METHODS:A total of 21 elderly patients with unstable intertrochanteric fractures underwent femoral head replacement. Simultaneously, we col ected clinical data of 20 elderly patients with unstable intertrochanteric fractures undergoing internal fixation of dynamic hip screw. Operation time, blood loss amount, time of walking practice after replacement, complications, and Harris score were compared between the two groups. Clinical effects in patients with femoral head replacement were observed.
RESULTS AND CONCLUSION:Al patients were fol owed up for averagely 20 months (ranged from 6 months to 36 months). After replacement, the incision was first healing. The operation time of femoral head replacement was short;blood loss amount was less;the time of walking practice was early. However, no significant difference in Harris score was detected between the two groups (P>0.05). After femoral head replacement, no infection, inversion and shift, or hip joint loose occurred. Results suggested that correct anteversion angle, eccentricity and femoral calcar size should be identified before the implementation of artificial joint replacement for the elderly femoral intertrochanteric fracture. After implantation of the prosthesis, reduction and fixation of trochanter and femoral calcar bony landmarks are simple easily operated surgery. It can reduce blood loss amount, shorten operation time and elevate clinical effects.

Objective To analyze the imaging features of hepatic angiomyolipoma (HAML) on computed tomography (CT) and magnetic resonance imaging (MRI).Methods The imaging fingdings of 18 tumors which were pathologically diagnosed as HAML after surgery were analyzed retrospectively.Before operation,twelve and ten patients underwent CT and MRI non-contrast and dynamic enhanced scans,respectively,and 4 patients received both examinations.The imaging characteristics including the number,diameter,location,appearance of the lesions,plain and dynamic enhancement mode were analyzed.Results Eighteen HAML lesions were found in 18 patients with a diameter ranging from 1.5 cm to 17.2 cm (mean 5.3 cm).Five lesions manifested fatty content,and one showed hemorrhage and necrosis.Five HAMLs enhanced in a fast-in and fast-out mode,eleven in a fast-in and slow-out mode and two other lesions in an irregularly discrete mode.The arterial supply was found in 11 HAMLs in the hepatic arterial phase,all coming from intrahepatic arteries.Intratumoral vessels were observed in 12 HAMLs.Early draining veins to the hepatic vein (n =3) and portal vein (n =1) were detected in 4 HAMLs.One lesion demonstrated delayed enhancement in the pseudocapsule.Conclusion The detection of arterial supply and intratumoral vessels in a hypervascular hepatic tumor on contrast CT and MRI in a patient with a non-cirrhotic liver and normal AFP helps to make a diagnosis of HAML.