3 Discussion 3.1 Femoral neck fracture is a common injury in orthopedics. Due to poor local blood flow, most of the elderly, fracture healing time, complications, fracture nonunion and femoral head necrosis rate, there are reports of 15% and 20%~30%112. The fracture site classification and age have a great influence on the prognosis. Many scholars have explored the treatment methods for many years. The surgical methods are simple internal fixation, such as three-wing nails and multiple pieces. Kirschner wire or Sterling needle, Ernier needle, compression screw internal fixation and internal fixation plus bone graft or total hip replacement. In recent years, our hospital has double-head cannulated compression screws and internal fixation with St. needles to adapt to the majority of femoral neck fractures with satisfactory results.
3.2 Main features of double-head compression screw and internal fixation (1) Simple and flexible operation: Because the closure is closed, the incision is small and does not need to be fully exposed.
Under the fluoroscopy, the position and direction of the guide needle are accurate. The guide needle has a scale to select a suitable length of compression screw. The operation is only 15~30min. (2) The injury is small and the risk is small: soft tissue damage is less, and the fracture is local. The blood supply is small, the diameter of a compression screw is 5mm, the total cross-sectional area of ​​the 3mm of the Sterling needle is less than 3 compression screws or one tri-wing needle, and the damage to the femoral neck and femoral head is small, old and frail and merged. Patients with chronic heart, brain, lung, kidney and kidney can also tolerate surgery. (3) The fixing is firm and the rotation is prevented: the double-head compression screw and the two Sterling needles form a three-dimensional structure, which effectively controls the rotation and the angular displacement. (4) Comply with the mechanical requirements: Because the three internal fixations pass the femoral moment through the fracture line and the tension bone beam and the pressure bone beam, the stress and shear force can be greatly affected. (5) wide indications, less complications: can adapt to the age of 65 years old, all types of fresh femoral neck fractures, old femoral neck fractures. Because of the strong and firm internal fixation, the internal fixation can be prevented from loosening out or entering the joints and pelvis. This type of surgery can also be performed for elderly osteoporosis. After the operation, the postoperative pain can be activated in bed, and after 2 weeks, the lower abdomen can not carry heavy weight activities, which is convenient for nursing, reducing various complications and promoting the recovery of systemic and local conditions.
3.3 Intraoperative and postoperative attention to strive for early surgery, which is conducive to the recovery of blood vessel distortion, compression or paralysis after fracture. Accurate and good reduction is an important condition for the success or failure of the operation, because the internal fixation only bears 25% of the stress, Lu Yupu, Qi Shaoting, Ge Baofeng, and so on. Practical orthopedics|M Bu Beijing: 636―652|2 Lu Yonghui, Yu Nansheng. Double-head compression screw attached to the femoral neck internal fixation treatment 10 (3) 156 | 3 戎 Limin. The choice of internal fixation for femoral neck fractures|J. Bone and Guan (upper page 291) This prevents mucosal eversion and avoids needle leakage, reducing the chance of anastomotic leakage; It is a “full-layer intermediate methodâ€, that is, each suture is always in the middle of the two sides of the cutting edge. After a full-layer suture for 1 week, the serosa is embedded for 1 week to ensure that the anastomosis meets the conditions of upper space, positive and negative. .
The most common complication after primary resection of colorectal cancer intestine is liquefaction of the incision fat and infection of the incision. There were 7 cases in this group, and the causes were closely related to the malnutrition, hypoproteinemia, anemia and other organ diseases. It was also related to the improper use of incision infection and electrocautery. A complication, the incision dressing should be strengthened, if necessary, the incision skin is open to achieve adequate drainage, while strengthening nutrition and supportive treatment, correcting the imbalance of water, electrolytes and acid and alkali. The other is anastomotic leakage, which is the most serious complication. Once it occurs, it can cause fecal peritonitis, the mortality rate can be as high as 25%~45%|46L. The reason for its occurrence is not good for intestinal preparation, poor blood circulation. The anastomotic tension is high, the anastomotic suture is not tight, and the mucosal eversion is a very important factor. There were 3 cases of intestinal anastomotic leakage in this group, which appeared on the 7th to 12th day after operation. After adequate local effective drainage, the self-repaired leaks were performed after fasting, gastrointestinal decompression, deep vein high nutrition and effective antibiotic treatment. . Surgical treatment is required when peritonitis occurs in the anastomotic leakage. Prevention of anastomotic leakage |7 should: (1) pay attention to the improvement of systemic conditions; (2) prevent mistakes in surgical operations; (3) avoid abdominal cavity contamination
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