Clinical Research, Artificial Joint Replacement And Intramedullary Fixation For The Treatment Of Unstable Intertrochanteric Fractures

Purpose:To observe the clinical effect of the hip arthroplasty treating theunstable Osteoporotic intertrochanteric fractures in the eldly and toapproach the clinical significance.Material and method:40 advanced age patients(22 men and 18women)suffered by theunstable Osteoporotic intertrochanteric fractures in the eldly were selected from September2009 to December2010 in the shenyang orthopaedic hospital.The patients'ages were all older than 66and belonged to the unstable types according to Evans-Jensen classification. While 14 patients in the hip arthroplasty group,The ages were between 71 to 84 and the average agewas 76.The flow-up visit was between 5 months to 10 months ,and the average time of flow-up visit was 10 months. While the 26 advanced age patients suffered by the unstable intertrochanteric fractures in the eldlyin the Intramedullary fixed group.The ages were between 70 to 84 and the average age was75.The flup time was between 3 months to 16 months ,and the average time of flow-up visit was 9 months .Recorded the time and blood-transfusion during operation in both groups ,and fluped the ambulatory time ,the occurrence of complications and the FRS scores and Harris scores before operation and after operation ,and compared the scores decrease after operation.Results:There was significantly in operation time between the hip arthroplasty group and the Intramedullary fixed group (P<0.05).The time to ambulation in the hip arthroplasty group was shorter than that of the Intramedullary fixed group(P<0.01). The blood-transfusion duringoperation was compared in the two groups by Rank sum test and it showed that there was significantly in the volume of blood-transfusion between the hip arthroplasty group and the Intramedullary fixed group (P<0.05).There was no significant difference inpostoperative complications incidence rate between the two groups,but there were no complications related to lying in bed and caging in the hip arthroplasty group,while there were many postoperative complications in the Intramedullary fixed group because of the long time lying in bed .The decrease of FRS scores and Harris scores after operation was compared in the two groups by t-test and It showed that the curative effect of the hip arthroplasty group was better than theinternal fixation group(P<0.05).Conclusion:1 The hip arthroplasty can be one of the therapies to the unstable Osteoporotic intertrochanteric fractures in the eldly,but the operation indication should be chosen strictly and the propotionaltreatments should be taken during operation according to its characteristic and positive prophylaxis should be taken to reduce theoccurrence of complications.