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[Objective]To explore the surgical technique and clinical results of minimally invasive incision dynamic hip screws (DHS) in treatment of intertrochanteric fractures in the elderly.[Method]From August 2001 to January 2006,37 old cases (15 males and 22 females, aged from 72 years to 92 years, mean 81.5 years) with intertrochanteric fractures were treated with closed reduction and DHS using minimally invasive technique in our hospital. The procedure included following and critical steps:1～2 k-wires was inserted into the upper part of the femoral head through great trochanter percutaneously after operation. A guide wire was inserted into the center of the femoral head according to 135? collodiaphyseal angle; then, a small incision (4～5.5 cm) was made and along the guide wire for inserting a screw into the femoral head. The guide wire was removed and the side plate was slipped under the soft tissue into to tightly contact the lateral surface of femur, and followed by the side plate barrel being seated on the screw.[Result]The operation time was 40～75 minutes (average 60 minutes) The mean amount of blood loss in, operation was 55 ml. The mean amount of hemoaleh:in showed no significant difference between postoperation and preoperation. The following-up period averaged 15 months (11～18 months) The clinical hone healing lasted for 10～15 weeks. Two cases had mild coxa vara, there were no incision infection, fixation failure or lower extremity rotatory deformity. The excellent rate of joint function was 94.6% according to DONG's assay standard. [Conclusion]Minimally invasive incision DHS has the advantages of shorter operation time, less blood loss, little trauma, less complications and quick functional recovery and is an effective and safe method for treatment of femoral intertrochanteric fractures in the elderly.

9.Clinical characteristics and operative treatment of the ossification of ligamentum flavum thoracic spinal stenosis

Haibo ZHANG ; Yisheng WANG

Orthopedic Journal of China 2006;0(07):-

[Objective]To evaluate the clinical characteristics and effect of operative treatment for the ossification of ligamentum flavum thoracic spinal stenosis (OLF-TSS). [Methods]From October 1998 to February 2007,38 patients with OLF-TSS were treated with en bloc hemi-articular process laminectomy. In this group,25 cases were male,and 13 cases were female. The average age was 48 years (range,29～71 years). Totally 81.6% of the lesion was between T10～L1 intervertebral disc space.The average history was 10 months. There were 5.3 percent with protrusion of intervertebral disc of thoracio spine.[Results]Thirty-eight cases were followed-up for 1～8 years,with an average of 3 years and 6 months. Dural injury occurred in 4 cases of 38,3 cases appeared postoperative cerebrospinal fluid leakage. All cases were cured conservatively mainly with bed rest in the prostrate position. According to WANG's evaluation,25 had excellent results,11 had good results,2 had no change and none was poor,The excellent to good rate was 94.7% in this group. There were no patients with the wrong level. No patient neurological functions were deteriorated.[Conclusion]The chinical features of OLF-TSS are very complex. The common symptoms of the disease are progressive onset of numbness,weakness,low back pain,intermittent claudication of the lower extremities,constriction on trunk or lower limbs and sphincter dysfunction. The clinical presentation and neurological examination associated with X-ray film,MRI and CT were the important means of the diagnosis of the disease. Removal of the posterior wall of the thoracic spinal canal via the technique of en bloc hemi-articular process laminectomy is safe and effective to treat OLF-TSS. The strategy for diminishing fault and complications is to discriminate pathogenic segment (locating-diagnosis) and follow the principles of surgical procedure.