MINISTRY OF EDUCATION AND TRAINING - MINISTRY OF
DEFENSE
MILITARY ACADEMY
LE NGOC HAI
RESEARCH ON OSTEOPOROSIS SITUATION AND
RESULTS OF BIPOLAR HIP REPLACEMENT
SURGERY TO TREATMENT INTERTROCHANTERIC
FRACTURE IN THE ELDERLY
Specialization: Surgery
Code: 9720104
SUMMARY OF THE DISSERTATION OF MEDICINE
HANOI - 2020
WORKS ARE COMPLETED AT MILITARY ACADEMY
Science instructor:
1. Assoc.Prof.Dr. TRAN DINH CHIEN
Reviewer 1: Assoc.Prof.Dr. Ngo Van Toan
Viet Duc Hospital
Reviewer 2: Assoc.Dr. Nguyen Nang Gioi
Central Military Hospital 108
Reviewer 3: Assoc.Prof.Dr. Pham Dang Ninh
Military Medical Academy
The dissertation will be protected before the school-level thesis
dissertation council
at: 14:00 on October 10, 2019
The thesis can be found at:
1. National Library
2. Library of Military Medical Academy
QUESTION
1. The urgency of the topic
Intertrochanteric fractures in the elderly are very common, women
are more male than men, often due to falls. In the USA, it is estimated
that there are about 200,000 intertrochanteric fractured patients each
year, the mortality rate is up to 15% - 30%, mostly in patients over 70
years old, the cost of this type of treatment is about 10 billion USD a
year [1].
Intertrochanteric fractures are a large fracture, treatment is often
difficult in the elderly due to complex fracture properties, poor bone
quality (osteoporosis) and a combination of chronic systemic diseases.
The intertrochanteric fracture treatments have been studied and
applied such as fracture with DHS braces, locking braces, gama nails
or hip replacement, if properly indicated, the results will be good. The
choice of treatment for intertrochanteric fractured patients is based on
many factors such as age, fracture location, fracture properties and
bone quality. The intertrochanteric fractured patients have good bone
quality, firm fractures, age is not too high often indicated to combine
bones to preserve hip joints. However, in the case of elderly patients
with unstable fractures, fractures with fragments or osteoporosis, bone
resorption methods are often difficult, skeletal unstable so the rate of
bone fractures, false joints, or immediately high deviation. Moreover,
according to some studies, the failure rate is up to 50-56% [2], [3], [4],
after surgery the patient must have time to wait for bone to not move,
move early so easily develop more systemic complications such as
pneumonia, spleen ulcers. For these cases, many authors advocated
the replacement of the hip joint for bipolar purpose to help patients
recover early movement or sit up early to avoid systemic
complications due to prolonged immobilization of spleen ulcers.
pneumonia, urinary inflammation or other systemic diseases [2], [5].
To assess the quality of the head bone area on the femur, there are
many different methods such as X-ray, dual energy X-ray (DEXA),
CT.scaner or MRI [6], [7], [8], [9],[10]. In fact, surgical doctors often
rely on Singh's index (number of osteosarcoma in the femoral neck)
[6], or bone thickness [7], [11], however these methods The price of
osteoporosis accuracy is not high, depending on the shooting
technique, film quality, beam density and the level of readers. The
method of common osteoporosis diagnosis currently being widely
used in the world is bone density measurement according to DEXA
method [9], [12], [15]. This is a method of using dual-energy X-rays
that allows a quantitative assessment of bone mineral mass at a
specific location in the body, or measure bone mineral Density
(BMD), thus determining the bone or osteoporosis through T-score
index. This method is considered by the WHO to be the gold standard
for diagnosing osteoporosis [14].
In Vietnam, in recent years, many treatment facilities have
replaced the hip joint joint of bipolar for elderly patients with
intertrochanteric fractures. However, there is no agreement on the
indication and no studies have evaluated and monitored osteoporosis
status in elderly patients with broken intertrochanteric by DEXA
method. From the above fact, we conducted research on the topic
"Research on osteoporosis situation and results of Bipolar hip
replacement surgery for intertrochanteric fracture treatment in the
elderly"
2. Research objectives
- Survey of osteoporosis in the femoral head in patients ≥ 70 years of
age, intertrochanteric fractures were replaced with Bipolar by DEXA
method.
- Evaluate the results of Bipolar hip replacement surgery in elderly
patients with intertrochanteric fractures.
3. New contributions of the thesis
- The study showed that elderly patients with Intertrochanteric
fractures with osteoporosis of 1,2,3 degrees according to Singh's
degree were osteoporosis when measured by DEXA method with T-
score ≤ -2,5. The degree of osteoporosis in the areas of the head above
the femur is: T-score neck: -3.62 ± 0.55 (-4.7 to -2.6); T-score Troch:
-3.03 ± 0.44 (-4.4 to -2.5); Inter T-score: -3.02 ± 0.40 (-3.8 to -2.5); T-
score Wards = -3.91 ± 0.58 (-5.1 to -2.6); T-score total: -3,20 ± 0,53 (-
5,0 to -2,5). The rate of female osteoporosis is higher than that of men
with P <0.05.
- Contribute more experience in bipolar partial hip replacement
technique in elderly patients with femoral fractures: Cut the neck of
the femur, take the cap then fix and fix the debris. Retaining the end of
the bone in the femoral canal to fix and fix fragments and fractures,
thus correcting the fragments more easily and when using porous
screws or kirschner nails to connect the bones will avoid piercing into
the canal..
4. Layout thesis
The thesis consists of 116 pages, 45 tables, 3 charts, 16 pictures, 5
pictures, 7 sections
- Question: 2 pages
- Chapter I: Overview of 35 pages
- Chapter II: Subjects and research methods 17 pages
- Chapter III: Studying 26 pages
- Chapter IV: Discussion 34 pages
- Conclusion: 02 pages
- Recommendation: 01 page
Chapter 1: OVERVIEW DOCUMENT
1.1. Anatomical features of hip and intertrochanteric joints
The hip joint is a joint located deep under many thick layers of
muscle that surrounds [15], [16], [17]. According to De palma, LMC
is the bone area between the neck and femoral body, limiting from the
boundary of the collar in the base to the small 5cm transfer tab, Lord
thinks that under the small 2.5cm transfer tab, it is still considered the
transfer area [ 1]. Ward (1878) described 5 bones.
1.2. Osteoporosis and related issues
1.2.1. Elderly concept and osteoporosis
The elderly are Vietnamese citizens who are 60 years old or older
[22]. In 2001, WHO: osteoporosis was a pathological condition of the
skeletal system with reduced bone strength, leading to an increased
risk of bone fractures. Bone strength reflects the combination of bone
mineral density and bone quality [14],[26].