Comparison Of Clinical Efficacy Between Asian Anti-rotational Intramedullary Nail Of Proximal Femur(PFNA-Ⅱ) And DHS Combined With Anti-rotational Screw In The Treatment Of Senile Femoral Intertrochanteric Fracture

Objective: To compare clinical efficacy of Asian anti-rotational intramedullary nail of proximal femur(PFNA-II)with dynamic hip screw(DHS)combined with anti-rotational screw in treatment of femoral intertrochanteric fracture,and provide alternative internal fixation for the senile patients with femoral intertrochanteric fracture.Methods: Retrospective study was performed to 79 patients with femoral intertrochanteric fracture who underwent PFNA-II or DHS combined with anti-rotational screw from January 2014 to December 2015 in orthopedic of Si Hong people’s hospital of Jiangsu Province.There were 33 patients received PFNA-II and 46 cases received DHS combined with anti-rotational screw.there was no significant difference between the two groups(P >0.05).Follow-up were performed on 1,2,3 months postoperatively,and every 3 months after that.Clinical efficacy was evaluated by radio logical data,conditions of fracture healing,complications and postoperative hip function.Results: The mean incision length was(7.7 ± 0.7)cm in PFNA-II group and(12.2 ± 1.2)cm in DHS combined with anti-rotational screw group(P<0.05);The mean intraoperative blood loss was(181.8 ± 82.7)ml in group PFNA-II and(377.1 ± 201.3)ml in DHS combined with anti-rotational screw group(P<0.05);The mean postoperative walking time was(7.6 ± 1.0)days in group PFNA-II and(25.0 ± 3.6)days in DHS combined with anti-rotational screw group(P<0.05).All the 79 patients were followed up,and average follow-up was16.5 months(range,from 12 to 24 months).The mean fracture healing time was(10.6 ± 1.3)weeks in group PFNA-II and(13.7 ± 1.4)weeks in group DHS combined with anti-rotational screw(P<0.05);The mean harris score on 3th month postoperatively was(83.0 ± 4.1)points in group PFNA-II and(73.1 ± 6.3)points in group DHS combined with anti-rotational screw(P<0.05);The mean harris score on last follow-up was(90.4 ± 2.6)points in group PFNA-II and(88.5 ± 6.5)points in group DHS combined with anti-rotational screw(P>0.05).There was 1 case of proximal femur shortening,1 case of urinary infection,2 cases of deep vein thrombosis(DVT)and 1 case of hemorrhagic shock in group PFNA-II,meanwhile 2 cases of coxa adducta,1 case of bedsore,2 cases of DVT,2 cases of sliding of the hip screw occurred in group DHS combined with anti-rotational screw.There was no significant difference in postoperative complications between the two groups(P >0.05).Conclusions: Compared with DHS combined with anti-rotational nail,PFNA-Ⅱ had the advantages of less trauma,quick recovery,low complication rate and early ambulation.Although the DHS combined with anti-rotational nail could provide comparative Long-term outcomes compared with PFNA-II,no increased difficulty of operation,and easy to grassroots promotion.However,it should be cautiously adopted in the treatment of unstable intertrochanteric fracture for its high rate off ailure.