Clinical Research On Artificial Femoral Head Replacement And Two Kinds Of Internal Fixation In Treatment Of Senileunstable Intertrochanteric Fracture With Diabetes

Objective: To compare therapeutic effect of artificial femoral head replacementand two kinds of internal fixation in treatment of senile femoral unstableintertrochanteric fracture with diabetes, investigate peri-operative management.Methods:We retrospectively studied62senile diabetespatientswith unstableintertrochanteric fractureat orthopedics department of Second Affiliated Hospital ofDalian Medical University from October2010to December2012. In these patients,19cases treated byPFNA,27casestreated by LCP,16casestreated byartificial femoral headreplacement. We evaluated operation time,blood loss,postoperative ambulation time,postoperative complicationsand function of hip joint (Harris score).The SPSS19.0software package was used.Results: In this study, no complications occurred in peri-operative period.(1)There was no statistical significance on operation time and postoperative complicationsin three groups (P>0.05). And no bed-related complications occurred in thegroup ofartificial femoral head replacement.(2) The blood loss inthe PFNA group was less thanthat in the LCP group andthe group of artificial femoral head replacement, thedifference was statistically significant (P <0.05). The difference was not statisticallysignificant between the LCP group and the group ofartificial femoral head replacement.(3) Postoperative ambulation time in the group of artificial femoral head replacementbetter than that inthe PFNA group and the LCP group, the difference was statisticallysignificant. Andpostoperative ambulation time in the PFNA group better than that in theLCP group, the difference was statistically significant (P <0.05)(4) According to theHarris hip score, excellent (≥90points), better(80～89points), good (70～79points),and poor (<70points), the excellent and good rate was92.6%in the PFNA group,84.2%in the LCP group,93.8%in the group of artificial femoral head replacement.There was statistically significant difference in the excellent and good ratebetween the LCP group and the PFNA group, between the LCP group and the group ofartificial femoral head replacement (P <0.05), no significant difference between the PFNA group and the group of artificial femoral head replacement (P>0.05).Conclusion: For senilediabetic patients with unstable intertrochanteric fractures,we should control blood sugareffectively, treat medical diseaseactively and do surgeryoperation as soon as possible. Active peri-operative management was the key to thetreatment of senile diabetic patients with unstable intertrochanteric fractures. We shouldtake account of many factors, such as the age of patients,health condition, joint activitiesbefore the injury, fracture type, economic conditions and so on, then select the propersurgical operation. The treatment of PFNA, LCP and artificial femoral headreplacement are applicablefor unstable intertrochanteric fracture. Patients withthetreatment of artificial femoral head replacement can ambulate early, reduce the time inbed and the occurance of bed-relatedcomplications,avoid other complications such aslooseningof internal fixation and splitting of femoral shaft. Senile patients with diabetesare unfavorable prolonged bed rest, sothe treatment ofartificial femoral headreplacement has a distinct advantage over the internal fixation.