Objective:To evaluate the influence of optimized rehabilitation process on prognosis of old patients with Evans type III and IV femoral intertrochanteric fractures and investigate the related efficacy.Methods:A retrospective case-control study was performed on 207 old patients with Evans type III and IV femoral intertrochanteric fractures fixed by proximal femoral nail anti-rotation (PFNA Ⅱ) in People's Hospital of Chongqing Banan District from March 2012 to January 2017. Normal rehabilitation group ( n=100) had rehabilitation education and training after operation and started off-bed exercise at postoperative 48 hours, including 38 males and 62 females, with age from 65 to 75 years in 69 patients and 75 years and over in 31 patients. There were 49 patients with Evans type III fractures and 51 with Evans IV fractures. Optimized rehabilitation group ( n=107) had rehabilitation education and training at admission and started off-bed exercise within 48 hours after operation, including 43 males and 64 females, with age from 65 to 75 years in 79 patients and 75 years and over in 28 patients. There were 63 patients with Evans III fractures and 44 with Evans IV fractures. Operation time, intraoperative bleeding, complications during hospital stay, fracture healing time, internal fixation rupture, femoral head cut, second fracture and mortality rate were recorded and compared between the two groups. Harris hip score was evaluated at postoperative 3, 6 and 12 months. Results:All patients were followed up for 3-12 months, with the average of 11.6 months. Normal rehabilitation group showed introperative bleeding of (119.3±1.9)ml and operation time of (1.13±0.22)hours, which were not significantly differed from that in optimized rehabilitation group [( 121.6±1.2)ml, (1.07±0.25)h] ( P>0.05). In normal rehabilitation group, the complications were hypostatic pneumonia in 19 patients, heart failure or acute myocardial infarction in 8, urinary infection in 18, lower-extremity deep vein thrombosis in 5, pressure ulcer in 4, with 5 deaths within 3 months after surgery. While in optimized rehabilitation group, the complications during hospitalization were hypostatic pneumonia in 6 patients, urinary infection in 6, heart failure or acute myocardial infarction in 1, lower-extremity deep vein thrombosis in 1, pressure ulcer in 0 during hospital ( P<0.05). Within 3 months, mortality rate was 5% in normal rehabilitation group compared to zero in optimized rehabilitation group ( P<0.05). At postoperative 3 months, 6 months and 12 months, Harris hip scores in optimized rehabilitation group[(69.7±6.3)points, (80.2±4.6)points, (89.3±10.2)points] were significantly higher than that in normal rehabilitation group [(53.6±5.4)points, (75.1±9.2)points, (77.5±7.5)points]( P<0.05). Fracture healing time, internal fixation rupture, femoral head cut, second fracture and mortality rate at postoperative 12 months had no significant differences between the two groups ( P>0.05). Conclusion:Optimized rehabilitation process can improve hip function, reduce complication rate and mortality rate at postoperative 3 months in old patients with Evans type III and IV femoral intertrochanteric fractures, which deserves clinical application.

Objective To investigate the effect of dorsal index finger flap pedicled with radial digital proper artery for reconstruction of thumb skin defect.Methods A retrospective case series study was conducted on the clinical data of 78 patients with thumb skin defect admitted from August 2009 through September 2015.According to the treatment method,the patients were divided into Group A which adopted dorsal index finger flap pedicled with radial digital proper artery and Group B which adopted the conventional dorsal index finger flap for the reconstruction of thumb skin defect.Group A (n =47) comprised of 31 males and 16 females,aged averagely 29.6 years (range,20-54 years),and Group B (n =31) comprised of 22 males and nine females,aged averagely 27.3 years (range,19-55 years).The dimensions of skin defect were (9.02 ±0.45)cm2 in Group A and (7.15 ±0.72)cm2 in Group B.The cut flap area,operation time,postoperative visual analogue score (VAS),flap survival rate,two point discrimination recovery,and evaluation criteria of the upper limb function of the Chinese Medical Association (joint activity,shape,muscle strength,sensory recovery,sequelae,and work ability) were compared between Groups A and B.Results The cut flap area was (9.25 ± 0.78) cm2 in Group A and (7.25 ± 0.61) cm2 in Group B (P ＜ 0.05).The operation time was (1.75 ± 0.36) hours in Group A,and (1.64 ± 0.29) hours in Group B (P ＞ 0.05).The VAS was (7.40 ± 0.36) points in Group A,and (6.33 ± 0.47) in Group B (P ＞ 0.05).All flaps of Group A survived without any epidermal necrosis or bister,with the survival rate of 100％;while four cases of Group B had partial or total necrosis,with the survival rate of 87％ (P ＜ 0.05).The two point discrimination was (6.33 ± 1.41) mm in Group A,and (8.80 ± 1.43)mm in Group B (P ＜ 0.05).According to the evaluation criteria of the upper limb function of the Chinese Medical Association,the results of Group A were excellent in 21 cases,good in 22,and poor in four,with the excellent and good rate of 92％;while the results of Group B were excellent in 14 cases,good in 8,poor in 5,and worst in 4,with the excellent and good rate of 71％ (P ＜ 0.05).Conclusion Dorsal index finger flap pedicled with radial digital proper artery for the reconstruction of thumb skin defect is worthy of clinical practices,for the advantages of larger cut flap area,improved flap survival rate and quality,and better recovery of upper limb function.