Objective To observe curative effects of augmentation fixation technique injected with PMMA through lateral holes of dynamical hip screw (DHS) in treatment of unstable intertrochanteric fracture of senile osteoporotic patients. Methods From January 2006 to December 2007,15 senile osteoporotic inpatients with unstable femoral intertrochanteric fracture were treated with augmentation technique injected with PMMA to the femoral head through central channel and lateral holes of DHS. Clinical data about function of hip joint and complications early after operation were observed. All patients were followed up till fractures were healed, when the hip joint function was evaluated according to Harris standarch. Results Surgical trauma indices such as operation time and bleeding volume of augmentation technique were the same as those of merely DHS fixation. All the patients could safely do hip flexion and extension exercises in the bed and completely sit up by bedside 2-3 days after operation. Six patients could do walking exercise with aid one week after operation, with no complications relating to staying in bed or to PMMA during per-operation period. All fractures were healed 3-6 months after operation, without complications like fixation loosening, cut or destruction of femoral head during postoperative follow-up period. Six months after operation, 14 patients recovered viability to normal. According to Harris standards, the results were excellent in four patients, good in 10 and fair in one, with average Harris score of 83 points. Conclusions The augmentation fixation technique injected with PMMA through lateral holes of DHS has advantages of better DHS anchoring ability in femoral heads, less surgical trauma, reliable fixation and early functional exercise and is suitable for senile osteoporotic patients with unstable intertrochanteric fractures.

BACKGROUND: In recent years, the method of bladder reconstruction is still at the experimental stage. Therefore, anatomical study is necessary for its clinical application.OBJECTIVE: To provide anatomical bases for the selection of proper spinal roots, the ideal level for cross anastomosis, and the identification of anterior roots of spinal nerves during bladder functional reconstruction with Achilles tendon reflexes.DESIGN: It was a single sample study with anatomical specimen as subjects.SETTING: The experiment was conducted in the department of orthopaedics of a municipal hospital.PARTICIPANTS: The experiment was completed in the Department of Anatomy, Second Military Medical University of Chinese PLA, from May 1999 to January 2000. Altogether 20 adult corpse specimens (14 males and 6females, 40 sides) were involved.INTERVENTION: The origin of spinal roots of the sacral plexus and sciatic nerve, the distribution of corresponding spinal root between the sciatic nerve and other nerves were followed up.MAIN OUTCOME MEASURES: Overlapping length, horizontal area, and relative position of anterior roots of L4-S4 spinal nerves in the dura mater.of S2 -4 anterior spinal roots originating from the spinal cord was higher than that of L4, L5 and S1 anterior spinal roots running through the dura; the cross-sectional area of L4(2. 19 ±0.39) mm2, L5(2.58 ±0.58) mm2 and S1(2.19 ± 0.42) mm2 anterior spinal roots was more than that of S2-4 anterior dentify their sequence at the terminal cone level than under this level.should be taken during bladder functional reconstruction with Achilles tendon level.