10.3969/j.issn.2095-4344.2013.25.024

BACKGROUND:Intertrochanteric fracture can obtain good curative effects after active effective internal fixation in early stage.
OBJECTIVE:To compare dynamic hip screw+trochanter stabilizing plate and Gamma nail fixation for treatment of Evans type IIIB and type IV intertrochanteric fracture.
METHODS:A total of 67 patients with Evans type IIIB and type IV intertrochanteric fracture, including 28 cases undergoing dynamic hip screw+trochanter stabilizing plate and 39 cases undergoing Gamma nail, were selected from Chongming Branch, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from February 2009 to November 2012. Al patients received antibiotics and functional exercises after treatment. Time of therapy, intraoperative bleeding amount, fracture healing time and Harris Hip Score were retrospectively analyzed in patients of both groups.
RESULTS AND CONCLUSION:Al patients were fol owed up for 6-45 months, averagely 21 months. (1) One patient affected infection in the dynamic hip screw+trochanter stabilizing plate group. He was healed after fixation removal half a year after drug exchange. One obese patient experienced injury again during out-of-bed activity at 3 weeks after treatment in the Gamma nail group. Fracture appeared at distal end of lock pin, and healed after replaced by Gamma nail. Trochanteric stabilizing plate was unstable in four patients of the Gamma nail group. They affected severe pneumonia after over 6 weeks of lying in bed, and healed after treatment in the medical department (2) Coxa vara appeared in two cases of the dynamic hip screw+trochanter stabilizing plate group, and three cases in the Gamma nail group. Fracture healing was achieved in al patients. (3) The time of therapy was longer, and intraoperative bleeding amount was significantly more in the dynamic hip screw+trochanter stabilizing plate group compared with the Gamma nail group (P<0.05). No significant difference in healing time and Harris Hip Score was detected between the two groups (P>0.05). Dynamic hip screw+trochanter stabilizing plate and Gamma nail are effective methods for treatment of Evans type IIIB and type IV intertrochanteric fracture. To choose a suitable fixator, we should aggregately analyze fracture stability, healing state and the degree of osteoporosis.

Obj ective To compare the difference of therapeutic efficacy of autologous and allogenic tendon for reconstruction of the ligaments of the lateral ankle by minimally invasive trans-plantation.Methods A total of 70 patients with reconstruction of the ligaments of the lateral ankle by minimally invasive transplantation were selected and divided into autologous group (36 cases)and allogenic group (34 cases).Patients of 2 groups were performed with minimally invasive transplan-tation for reconstruction of the ligaments of the lateral ankle.Autologous group adopted semitendi-nosus tendon of the inside of ipsilateral limb for transplantation and allogenic group adopted allograft ligaments.The same rehabilitation training was given for 2 groups after transplantation.Results The time of transplantation in autologous group was significantly longer than allogenic group (P<0 .0 1 )but the time of fever and wound healing of autologous group was shorter than allogenic group (P<0.05,or P<0.01).The score of ankle and exopodal,slant angle and migration distance of astragalus significantly improved (P<0.01),but there was no significant difference (P>0.05). After 2 years of follow up,the rate of good efficacy of autologous group was 74.29%and allogenic group was 68 .75%,and there was no significant difference between 2 groups (P>0 .05 ).Conclu-sion Either Autologous tendon or allogenic tendon has advantages and disadvantages in reconstruc-tion of the ligaments of the lateral ankle by minimally invasive transplantation,the operation should be selected according to the condition of the patients.

Obj ective To compare the difference of therapeutic efficacy of autologous and allogenic tendon for reconstruction of the ligaments of the lateral ankle by minimally invasive trans-plantation.Methods A total of 70 patients with reconstruction of the ligaments of the lateral ankle by minimally invasive transplantation were selected and divided into autologous group (36 cases)and allogenic group (34 cases).Patients of 2 groups were performed with minimally invasive transplan-tation for reconstruction of the ligaments of the lateral ankle.Autologous group adopted semitendi-nosus tendon of the inside of ipsilateral limb for transplantation and allogenic group adopted allograft ligaments.The same rehabilitation training was given for 2 groups after transplantation.Results The time of transplantation in autologous group was significantly longer than allogenic group (P<0 .0 1 )but the time of fever and wound healing of autologous group was shorter than allogenic group (P<0.05,or P<0.01).The score of ankle and exopodal,slant angle and migration distance of astragalus significantly improved (P<0.01),but there was no significant difference (P>0.05). After 2 years of follow up,the rate of good efficacy of autologous group was 74.29%and allogenic group was 68 .75%,and there was no significant difference between 2 groups (P>0 .05 ).Conclu-sion Either Autologous tendon or allogenic tendon has advantages and disadvantages in reconstruc-tion of the ligaments of the lateral ankle by minimally invasive transplantation,the operation should be selected according to the condition of the patients.