| Objective:Compared extramedullary fixation system with intramedullary fixation system for treatment of intertrochanteric fractures.Methods:Retrospective analysis from January 2005 to March 2010,we treated 49 cases of admitted patients with Intertrochanteric Fractures(according to AO classification, there are 14 cases of A1-type, 26 cases of A2-type,9 cases of A3-type),in which 16 cases treated with DHS,10 cases treated with DCS,8 cases treated with Gamma nail, 7cases treated with PFNA,the other 8 cases included screws,arthroplasty. DHS and DCS has been classified as extramedullary screw-plate system; the Gamma nail and PFNA classified as intramedullary system. Compared the difference of the methods in the two groups in length of stay, operation time, amount of bleeding in operation, healing time of fracture, complications such as Coxa vara, Internal fixation fail,Injury limbs shortening, Screw cut out, Femoral shaft fractures etc.and hip joint function score(Harris score).Results:In 49 cases of patients, in addition to 2 deaths,5 cases were lost,the other 42 patients received an average of 27.8 months (3.0～56.0 months) follow-up.1.Length of stayThe two groups during hospitalization in patients with no deaths.In the extramedullary fixation system In average hospitalization time which DHS group is 10～28 days,with an average length of stay is 19.7 days, DCS Group is 15～25 days,with an average length of stay is 20.7 days.In intramedullary fixation system which Gamma nail group is 20～43days, the average length of stay is 26 days, PFNA group 13～27 days, the average length of stay is 18.7 days.There were no significant differerces between the two group in comparison of the length of stay (t=-1.404, P =0.168,P>0.05).2.Operation timeIn extramedullary fixation system which the group of DHS is 90～220 minutes, with an average of it is 137.2 minutes;the group of DCS is 110～255 minutes, with an average of it is 150.5 minutes. And in intramedullary fixation system which the group of Gamma nail is 40～320 minutes, with an average of it is 140 minutes;the group of PFNA is 40～190 minutes, with an average of it is 125.8 minutes.There were no significant differerces between the two group in comparison of the operative time.(t=0.843,P=0.405,P>0.05)3.Amount of bleeding in operationIn extramedullary fixation system which the group of DHS is 100～1000ml, an average amount of bleeding in operation is 425.0ml;the group of DCS is 200～1500ml, an average of it is 460.0ml. In intramedullary fixation system which the group of Gamma nail is 200～1000 ml, an average of it is 387.5ml;the group of PFNA is 100～1500ml,an average of it is 416.6ml.There were no significant differerces between the two group in comparison of the amount of bleeding in operation.(t=1.035,P=0.307,P>0.05)4.Healing time of fracture In extramedullary fixation system which the group of DHS in fracture healing time is 9-16 weeks,with an average of it is 12.8 weeks; the group of DCS is 9-20 weeks,with an average of it is 13.6 weeks.In intramedullary fixation system which Gamma nail in fracture healing time is 12～16 weeks,with an average is 14.7 weeks;the group of PFNA is 12～16 weeks, with an average is 13.3 weeks.There were no significant differerces between the two group in comparison of the healing time of fracture.(t=-1.376,P=0.178,P>0.05)5.ComplicationIn extramedullary fixation system which there are 2 cases dead in the group of DHS,the cause of death are unrelated to the fracture(1 patient died of brain cancer and the other one died of coronary heart disease),the deaths were not incorporated into the statistical analysis.In inramedullary fixation system which there is one case of screw broke into the joint cavity in the group of Gamma nail and one case of postoperative myositis ossificans in the group of Gamma nail.There is one case in PFNA group according to postoperative X-ray showed that spiral blade of poor location.There were significant differerces between the two group in comparison of the complication(X2=10.032, P=0.031,P<0.05).6. Hip joint function(Harris score)In extramedullary fixation system which the hip function score in the group of DHS is 58～99, an average of it is 89.7;DCS group is 84～99,an average is 92.2.But in intramedullary fixation system that the score of Gamma nail hip joint function is 60～95,with an average is 85.0; PFNA group is 58～比99, an average of it is 88.1.There were no significant differerces between the two group in comparison of the hip joint function.(t=1.627,P=0.115,P>0.05)Conclusion1.Both extramedullary and intramedullary fixation system can treat all types of intertrochanteric fracture, and they have achieved good outcome, there was no significant difference in efficacy when compared.2.MIPPO technology used in extramedullary fixation system contributes to reduce the patients'surgical trauma,the patients'blood loss, and who can recovery faster, It is particularly suited to the grave fractures. |
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