Randomized controlled trials of proximal femoral nail antirotation in lateral decubitus and supine position on treatment of intertrochanteric fractures.

The objective of this study was to compare the clinical results and complications of proximal femoral nail antirotation (PFNA) on treatment of intertrochanteric fractures in 120 elderly Chinese patients using Randomized Controlled Trials (RCTs). Totaly 120 cases enrolled were randomly assigned to a lateral decubitus position group and supine position group. The hospital stay, operating time, intraoperative blood loss, length of incision, X-ray fluoroscopy time, and out-of-bed activity time in the lateral decubitus position group were significantly lower than those in the supine position group. There was not statistical significance on union time and Harris values in the two position groups. Moreover, only complications of superficial wound infection were observed in the lateral decubitus position group, but two complications of deep venous thrombosis and wound deep infection were found in the supine position group. The present findings suggested that PFNA applied in elderly patients with intertrochanteric fracture can get satisfactory effects, and the treatment of intertrochanteric fractures using lateral decubitus position showed a satisfactory clinical outcome and a lower radiological complication rate.

[New surgical approach for presacral lesion by double door via S(3-5)].

OBJECTIVE: To investigate a new surgical approach for presacral lesion by double door via S(3-5). METHODS: From June 2007 to January 2008, 5 female patients (56-84 years old) with presacral lesion were treated. One patient had straining feeling in anus, 2 patients had difficult defecation and bloody stool and 2 patients had no symptoms. Digital rectal examination revealed rectal tumor in 2 cases and anus examination of presacral tumor showed no abnormality in 3 cases. B-ultrasound, CT and MRI examination displayed presacral tumor in 3 cases and rectumal tumor in 2 cases. The size of the lesions was 4 cm x 3 cm x 3 cm - 20 cm x 15 cm x 13 cm. The disease course was 12-50 days (average 18 days). All 5 patients received total resection of tumor through the surgical approach featured by double door via S(3-5). RESULTS: The operations were successful in all the 5 patients, and no severe presacral venous hemorrhage, rectal injury, direct injury of pelvic nerve and structure damage of pelvic bottom occurred during operation. The approach exposure time was 12-28 minutes (average 20 minutes) and the blood loss for approach was 30-130 mL (average 80 mL); and the operation time was 80-120 minutes (average 105 minutes) and the blood loss during operation was 100-350 mL (average 280 mL). All incision healed by first intention. Pathological examination of resected tissue after operation revealed presacral teratoma in 1 case, dermoid cyst in 1 case, spindle cell tumor in 1 case and rectal tubiform villus adenoma in 2 cases. All the patients suffered from perineal hypoesthesia to various degrees after operation, which were recovered to the normal 6 months later, and X-ray films showed bone union occurred in all the cases. No gatism occurred. During the followed-up period of 6-13 months, no sacrum defect, pelvic instability and sacroiliitis was observed in the 5 cases. B-ultrasound, CT and MRI examination showed no recurrence of tumor. CONCLUSION: The approach of double door via S(3-5) is a simple and safe surgical procedure featured by a good surgical exposure with less bleeding, short operative time, no sacrum defect, no severe sacral nerve damage, and early postoperative convalescence.