Different Internal Fixation Methods For The Treatment Of Intertrochan Teric Fracture Of The Femur In The Elderly

Objective:There are many challenges in the treatment of intertrochanteric fractures.For a long time,the research on the treatment of femoral intertrochanteric fractures,especially for the elderly,has never stopped.The main objective of this study was to analyze and compare the efficacy of DHS,LPFP,PFNA and InterTan in the treatment of elderly intertrochanteric fractures.Methods:A retrospective analysis was performed on 99 elderly patients with intertrochanteric femoral fractures treated with internal fixation in the department of orthopaedics of chongzhou people’s hospital from July 2009 to June 2016.Surgical operation time,incision length,actual total blood loss,dominant blood loss,recessive blood loss,clinical fracture healing time,postoperative full weight bearing time,postoperative hip Harris score,postoperative joint function recovery,and complications were recorded for each patient.To analyze and compare the efficacy of four internal fixation methods: DHS,LPFP,PFNA and InterTan.The case data were classified and sorted out,the measurement data were expressed by standard deviation,the group comparison was expressed by unpaired t test,the adoption rate of count data was expressed by x test,P<0.05 was considered statistically significant,and all data were analyzed and processed by SPSS 22.0 statistical software package.Results:Baseline comparison of the four groups of patients: in this study,20 patients received DHS fixation,23 patients received proximal femoral locking plate fixation,27 patients received PFNA fixation,and 29 patients received InterTan internal fixation.There was no significant difference between the four groups in gender composition,mean age,fracture type and underlying disease,P>0.05.comparison of basic surgical conditions among the four groups: the InterTan group had the shortest operative time,which was significant compared with the other three groups(P<0.05).In the other three groups,the operation time of LPFP was the longest,which was significantly different from that of DHS and PFNA(P<0.05).There was no significant difference between DHS and PFNA groups(P>0.05).The InterTan group had the shortest incision length,which was significantly different from DHS group and LPFP group(P<0.05),but not significantly different from PFNA group(P>0.05).There were significant differences between the PFNA group and the DHS and PFNA groups(P<0.05).There was no significant difference between DHS and PFNA groups(P>0.05).From the perspective of dominant blood loss in the four groups,the blood loss in PFNA and InterTan groups was lower than that in DHS and LPFP groups(P <0.05),while there was no significant difference in dominant blood loss between PFNA and InterTan groups(P>0.05),and there was no significant difference in dominant blood loss between DHS and LPFP groups(P>0.05).Invisible blood loss was significantly higher in the PFNA and InterTan groups than in the DHS and LPFP groups(all P <0.05).There was no significant difference in invisible blood loss between the PFNA and InterTan groups(P>0.05).There was no significant difference in invisible blood loss between the DHS and LPFP groups(P>0.05).From the total intraoperative blood loss and intraoperative blood transfusion volume,the total blood loss/transfusion volume of PFNA and InterTan group was higher than that of DHS and LPFP group,and there was a significant difference(P>0.05).However,there was no significant difference in the total bleeding/blood transfusion volume between PFNA and InterTan groups(P>0.05),and there was no significant difference in the total bleeding/blood transfusion volume between DHS and LPFP groups(P>0.05).Harris scores and postoperative range of motion of the four groups were compared.One month after the operation,Harris scores of the InterTan group were significantly different from those of the other three groups(P<0.05),while there was no significant difference between the other three groups(P>0.05).Six months after surgery,Harris scores of patients in the four groups showed no significant difference(P>0.05).12 months after surgery,Harris scores of patients in the InterTan group were not significantly different from those in the PFNA group(P>0.05),but were significantly different from those in the DHS group and the LPFP group(P<0.05).Postoperative 1 month and 6 months postoperatively,InterTan and PFNA group was significantly higher than the joint function in patients with DHS,LPFP group,had significant difference(P<0.05),the DHS group,LPFP joint recovery was compared between the way,there is no significant difference(P>0.05),the system of joint function in patients with InterTan and PFNA group was compared,no obvious difference(P>0.05);12 months after surgery,the rate of excellent and good joint function in the InterTan group was significantly higher than that in the PFNA group,the DHS group and the LPFP group,with significant differences(P<0.05),while there was no significant difference among the three groups(P>0.05).comparison of complications among the four groups: postoperative,among the patients using DHS internal fixation,1 patient had screw prolapse,1 patient had screw perforation of femoral head,and 1 patient had screw fracture.In the LPFP group,there was 1 case of screw prolapse,1 case of screw perforation of femoral head,2 cases of screw fracture,1 case of femoral head incision,and 1 case of bone nonunion,with a higher complication rate of 26.08% than the other three groups(P<0.05).Screw prolapse occurred in 1 patient in PFNA group,and no complications were found in the remaining patients.postoperative total weight bearing time of the four groups: System of InterTan and PFNA group is obviously better than the full load time and postoperative LPFP and DHS group,four group comparison system InterTan group of about 5 to 6 days of the hip can fully load,and postoperative PFNA group full weight-bearing time about a month or so,LPFP and DHS group,need 3 months postoperatively,almost all around side body can be fully load,there is statistical significance(P<0.05).The four groups of pair-wise comparison,The differences between InterTan group and PFNA group,LPFP group and DHS group were statistically significant(P<0.05),while the differences between PFNA group,LPFP group and DHS group were statistically significant(P<0.05),while the differences between LPFP group and DHS group were not statistically significant(P>0.05).comparison of the healing conditions of the four groups: among the four groups,the healing time and healing rate of the InterTan group and the PFNA group were significantly better than those of the LPFP group and the DHS group,with statistically significant differences(P<0.05).There was no significant difference in healing time and healing rate between the LPFP group and the DHS group(P>0.05).There was no significant difference in healing time and healing rate between the InterTan group and the PFNA group(P>0.05).Conclusion: 1.In terms of operation time and incision length,InterTan is the most superior,while LPFP has the longest operation time,which is unfavorable for surgery.The actual total blood loss/transfusion volume in PFNA and InterTan groups was higher than that in DHS and LPFP groups,mainly due to the large amount of recessive blood loss.Therefore,special attention should be paid to the data of blood volume,hematocrit and drainage volume when operating these two kinds of surgeries.It also indicates that the hidden blood loss must be included in the clinical outcome of this kind of surgery.2.The InterTan group had the fastest recovery time of hip Harris score,which is conducive to the recovery of patients;However,one year after the operation,the Harris scores of the patients in the InterTan group and the PFNA group were higher than those in the other two groups,indicating that these two surgical methods could reduce the pain,restore the function and reduce the limb deformity of the patients with hip joint.In terms of the excellent and good rate of joint recovery,patients in the InterTan group and the PFNA group had significant advantages at 1 month and 6 months after the operation,but in the long term,the advantages of the InterTan group were more obvious.3.The incidence of complications was highest in the LPFP group,and there was no significant difference among the other three groups.This is not consistent with the results of some studies showing that LPFP can reduce and avoid surgical trauma and reduce complications,which may be due to the statistical deviation caused by the small sample size in this study.Further research should be carried out.4.The loading time of the four groups of patients in the InterTan group and PFNA group was significantly shorter,while the loading time of DHS and LPFP was longer,which was consistent with the previous findings that LPFP patients were re-hospitalized due to early loading.5.The healing time and healing rate of InterTan group and PFNA group were significantly better than those of LPFP group and DHS group.It indicates that the InterTan group and PFNA group have more advantages for the elderly physique.