Early Effect Analysis Of Spiral Blade Position On Proximal Femoral Nail Anti-Rotation(PFNA) For Unstable Type Intertrochanteric Fractures

Objectives: To study the application of Proximal Femoral Nail Anti-rotation(PFNA)fixation in the treatment of unstable intertrochanteric fracture,and by comparative analysis the curative effect of spiral blade under different regions or different Tip Apex Distance(TAD)in the femoral head in patients with postoperative follow-up,provide clinical reference about placement of the screw blade.Methods: Retrospective analysis 53 patients(Postoperative time ≥ 6months)range from October 2014 to July 2016 in our hospital who with PFNA treatment of intertrochanteric fractures.Sectionalization to two groups(A and B)according to the postoperative position of spiral blades in different area of the femoral head(positive X-ray is slice in three areas: up,mid,down;side X-ray slice in three areas: former,centre and lateral.So the description of the femoral head interior space can be divided into 9 zones: a,b,c,d,e,f,g,h,i),Group A:spiral blade in the femoral head is:h e(positive X-ray is in the middle position,side X-ray is in the centre).Group B: other area(a,B,d,f,g,i).Respectively compare the postoperative position of spiral blade in the different scope of TAD(TAD≤25mm、TAD>25mm)that two groups of postoperative patients with full weight-bearing time,fracture healing time,complications and after postoperative half year,the difference of the the TAD values,the hip joint function score and so on.Results: A total of 53 patients were included in this study.All Patients were healed and no death.The postoperative full weight-bearing time and healing time of group A was significantly shorter than the B group(P ≤0.01).The Harris score of group A after six months excellent rate was 83.9%,significantly higher than group B in 59.1%(P ≤0.05);the complication rate of group A afer postoperation six months was 6.5%,significantly lower than group B in 36.4%(P ≤0.05).when the postoperative spiral blade in TAD ≤ 25 mm range,the postoperative full weight-bearing time,healing time and postoperative half spiral blade shift incidence of the patients in the group B were lower than in the range TAD > 25 mm,and the difference was statistically significant.In group B,Harris score the excellent rate of spiral blade in TAD≤ 25 mm range than in TAD >25mm range more higher,and the difference was statistically significant(P ≤0.05);when the position of postoperative PFNA spiral blade in the femoral head(a,b,d,f,g,i)area and TAD > 25 mm,the complications after postoperative half year are relatively high,and the incidence rate in 46.2%.Conclusion: First,when spiral blade placed in the femoral head that lower-middle(x ray)and central(lateral X-ray)region,and TAD ≤ 25 mm,it would be increased in the stability of the fixed,best postoperative efficacy,least complications.Second,when spiral blade was not placed in the femoral head in the ideal position,the postoperative patients get better curative effect belong to the range that TAD ≤ 25 mm than TAD >25mm.Third,when the spiral blade was not placed in the ideal position of the femoral head,and the range was TAD > 25 mm,with postoperative relatively more complications and relatively poor recovery,so we should try to avoid during operation.