Treatment of 46 cases of femoral neck fracture with cannulated compression screw
Treatment of 46 cases of femoral neck fracture with cannulated compression screw (Zhebo Linyi District People's Hospital, Zibo 255400, China) Liang Wenqing, Li Guanglei, Guan Yuzhong, Chang Xihai, Zhang Hanyu, June 1999, we took hollow compression screws to treat 46 cases of femoral neck fracture, and achieved good results. The effect is reported below.
Clinical data: 26 males and 20 females in this group; aged 23-90 years old, average 62 years old (66% of those over 60 years old) according to Garden classification: 3 cases of type I, 22 cases of type 11 and type I 16 For example, 5 cases of type IV were classified according to location: 18 cases of head and neck type, 16 cases of middle neck type, and 12 cases of base type were classified according to stability: Linote angle <50*15 cases, 50*70°20 cases, >70°1 cases. There were 16 cases of hypertension, 15 cases of coronary heart disease, and 16 cases of chronic bronchitis. All the patients underwent surgery within 24-96 hours after injury, and there was no death during the operation.
Treatment: Continuous epidural anesthesia. Take supine position, suffering from hip pad height 6cm under X-ray TV screen, do internal rotation 15* abduction 30* limb traction (no need to reset for non-displaced femoral neck fracture), continuous traction fixation after reduction, under the greater trochanter Between 1.5-5cm, 3 guide pins were drilled into the direction of the femoral head, reaching 0.5cm below the bone cartilage, and the anteversion angle was maintained. The three needles were arranged in a "good" shape, and one needle passed through the X-ray of the femur. Prove that the positive and lateral position are good, and the cis-guide needle is screwed into three hollow nails of appropriate length, tightly attached to the lateral femoral cortex, and the wound is sutured. After operation time 30-45min, the affected limbs were placed in neutral 30* position, and the quadriceps muscles in the same bed were stretched in equal length. Pay attention to prevent the lower limbs from exercising after 2 weeks of lower limbs, and exercise the non-weight-bearing exercises after 3 months. The effect of weight-bearing exercise was started 6 months after surgery: 40 patients (87%) were followed up for 1-2 years. According to Shen Xia and other scoring criteria: excellent in 26 cases, good in 11 cases, poor in 3 cases, excellent rate of 92.5% in 3 cases of poor efficacy, 2 cases of femoral head necrosis, 1 case of nonunion, all Garden IV type fractures (head and neck type In 1 case, 2 cases of subtotal type) the rate of union was up to 15%, the rate of avascular necrosis of the femoral head was 20%~3C%. There were many factors causing necrosis of the femoral head, but mainly related to the timing, quality and internal fracture reduction. Fixed stability and early functional exercise and weight-bearing time. Through the treatment of 46 patients in this group, we have the following experience: 1 Under the conditions of the patient's general condition, it should be reset as soon as possible, because early reduction and fixation are beneficial to restore the blood flow of the fracture as soon as possible, which is beneficial to the reconstruction of blood circulation of the femoral head. 2 Due to the special anatomical relationship of the femoral neck, the shearing force at the fracture end is large, and it is difficult to maintain the correct alignment after the fracture is reset. Generally, surgery is needed. The cannulated screw can be pressurized up to 3118-3530.4N. After the three nails are tightened, it can be fully pressurized and fixed firmly. After the reduction of the femoral neck fracture in the group under fluoroscopy, the three nails are arranged in a "good" shape, and one is passed. The femoral distance reaches the maximum anti-rotation and anti-shear stress; at the same time, the two fracture ends of the femoral neck fracture are inserted, so that the limbs are slightly abducted to eliminate or reduce the shear stress and tensile stress, and the compression force is increased to promote fracture healing. 3 Early functional improper exercise and premature weight bearing are the main reasons for postoperative femoral neck fracture and avascular necrosis of the femoral head. After the fracture, the blood supply to the femoral head has not been well restored and reconstructed. Premature weight bearing causes necrosis and collapse of the femoral head with ischemia and bone atrophy. We believe that exercise with lower limb function exerciser 2 weeks after surgery can prevent disuse osteoporosis. Preventing the limbs from adduct within 3 months, and impairing the weight of the limbs within 6 months, significantly reducing the incidence of nonunion and avascular necrosis of the femoral head. 4 conservative treatment of certain types of fractures (Garden, type) can also generally cause fracture healing. However, the main organs of the elderly are inferior in function, and the physiological reserve capacity of each system is poor, and conservative treatment of chronic diseases (such as heart disease, chronic bronchitis, hypertension, etc.) can increase bed rest time and increase complications caused by prolonged bed rest. The surgical method is simple, easy to perform, small in damage, firm and firm, and can be used for early passive functional exercise of the affected limb, which is more suitable for elderly and infirm.
Clinical observation of thrombolytic therapy for 124 patients with acute myocardial infarction Qiao Lujun Liu Chuanmu Zhang Mingzhe (Shengli Oilfield Central Hospital, Dongying, Shandong 257034, China) In order to understand the effect of thrombolytic therapy for acute myocardial infarction and identify early interventional therapy, we used urine in 124 patients with acute myocardial infarction. The thrombolytic therapy of kinase, low molecular weight heparin calcium and aspirin is reported below.
Clinical data: 124 patients in this group, all meet the WHO criteria for diagnosis of acute myocardial infarction, except for non-Q-wave myocardial infarction and previous history of myocardial infarction. There were 98 males and 26 females, aged 32-72 years, including extensive anterior wall infarction in 18 cases, lateral wall infarction in 32 cases, anterior wall infarction in 12 cases, inferior wall infarction in 32 cases, inferior wall and posterior infarction in 9 cases, right Room + inferior wall infarction in 7 cases, inferior wall + anterior wall infarction method: All patients were routinely recorded 18-lead ECG on admission, blood routine, platelet, prothrombin time, myocardial enzyme spectrum, blood type. After admission, the water-soluble aspirin 0.3g was immediately taken for 5 days, and after 5 days, it was changed to 0 1g/day service: at the same time, 1.5 million U of urokinase (weight more than 75 kg to 2 million U) was dissolved in 100 ml of physiological saline. After 12 hours of dripping, add 0.5 ml of low molecular weight heparin calcium to the abdominal wall for subcutaneous injection twice a day for 7 days. 12-lead ECG was reviewed every half hour within 3 hours after thrombolysis (positive posterior wall, right ventricular infarction still 18-lead ECG) and ST-segment elevation (PST) according to anterior wall infarction I aVLVi~V6 Lead, inferior myocardial infarction, 1丨, 丨11, aVF lead and right ventricular V3r~V5i lead were determined, and the sum of ST segment elevation (2, ST) and ST segment before thrombolysis were obtained 2 hours after thrombolysis. The ratio of the height of the elevation (22ST) was 2, and the myocardial enzyme was measured every 2 hours after STG2ST thrombolysis, and was checked 10 times. According to the patient recovery
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