| Background:In recent years, as the ageing of society increasing constantly aggravate, patients with intertrochanteric fracture more and more, and Its treatment is also constantly updated.At present, there are many methods to treat intertrochanteric fracture in the elderly, but there are two main ways fixed:One is the external fixation system,which is represented by dynamic hip screw;The other is intramedullary fixation system,which is represented by proximal femoral nail anti-rotation.Objective:Through the study of the elderly patients with intertrochanteric fractures of the two most commonly used internal fixation methods:one is Proximal Femoral Nail Antirotation, the other is Dynamic Hip Screw, carry out a retrospective clinical study,to make clear the advantages and disadvantages of the two kinds of internal fixation methods,then choose the best method of treatmen for the clinical treatment of intertrochanteric fractures among this two internal fixation.Method:From January 2014 to May 2015,we choose 46 cases from our hospital Trauma department of orthopedics,which use DHS and PFNA to treat intertrochanteric fractures,it include 35 females and 11 males,24 cases in the PFNA group,which include 6 males and 18 female patients, the age is from 60 to 88 years old; 22 cases of DHS group,5 males and 17 females patients, the age is from 60 to 91 years old;The statistical analysis include the duration of operation,length of incision,amount of bleeding during operation, length of hospital stay, postoperative time, fracture healing time, complications and hip Harris scores.Results:All of the 46 patients were followed up for a period of 9 to 12 month, Patients with no loss of follow-up, no death occurred in the follow-up period. Two groups of patients on blood loss comparison:PFNA group blood loss was 70-200ml, mean blood loss was 140 ± 41ml, DHS group blood loss was 200-450ml, mean blood loss was 310+70ml, in the amount of bleeding between the two groups (P<0.05) has a significant difference. Two groups of patients in the operation of the incision length for comparison, The incision length of PFNA group was 3-6cm, the average incision length was 4.5cm, The incision length of DHS group was 10-15cm,which incision mean length diameter was 12.5cm,so in the comparison of incision length of operation (P<0.05) has a obvious difference. Two groups of patients in the duration of surgery for comparison,the duration of operation in group PFNA was 50-150min,with an average of 96.25±0.62min, The duration of operation in group DHS was 120-240min,the average duration of operation was 160.45 ±32.58min. In the duration of operation between the two groups (P<0.05) has a obvious difference. Two groups of patients compared in the time to walk after the operation, PFNA group postoperative ambulation time is 25-35 days, the average postoperative ambulation time was 29.92 ±2.48 days, DHS postoperative ambulation time is 40-50 days, with an average postoperative ambulation time was 44.59 ±3.53 days, so in the comparision of the two groups postoperative ambulation time were statistically significant (P<0.05). Two groups of patients in the hospital days for comparison, PFNA group was 10-24 days, the average number of days was 15.71±2.98 days, DHS group was 9-22 days, the average number of days was 16.86±2.85 days, the two groups of patients in the hospital day (P> 0.05) has no statistically difference. Then we compared the time of fracture healing of this two groups of patients, PFNA group was 9-12 weeks, with an average of 10.42±.28 weeks, DHS group was 11-15 weeks, with an average of 12.82±1.10 weeks, The two groups of patients with fracture healing time(P<0.05) has a obvious difference. There was no clear distinction in the postoperative complications and hip function (Harris score) between the two groups (P>0.05).Conclusion:For elderly intertrochanteric fractures, the PFNA and DHS are relatively good internal fixation methods for the treatment, at the same time the two internal fixation methods has no obvious difference in the aspect which include the length of hospital stay, postoperative hip function and postoperative complications, but PFNA has more advantages than DHS in some aspect,which either can reduce blood loss, or to be able to shorten the operation time, at the same time can reduce postoperative ambulation time and shorten healing time, therefore integrated point of view, it is a good choice that we use PFNA to treat elderly which has occured the intertrochanteric fractures. |
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