| Objective:To investigate the clinical effect of proximal sliding compression technique in the treatment of femoral intertrochanteric fracture in the elderly with the use of proximal femoral nail antirotation internal fixation and positive supportive reduction,and to guide the clinical treatment.Methods:Clinical data of 76 cases of elderly intertrochanteric fractures of the femur,who were treated in Department of Orthopedics and Traumatology,the Third Affiliated Hospital of Anhui Medical University(the First People’s Hospital)from August 2016 to August 2019 using proximal femoral nail antirotation treatment and positive support in intraoperative reduction,were retrospectively analyzed.The patients were divided into two groups according to the presence and absence of proximal sliding compression technology.Among them,42 cases were in the sliding compression group,aged(76.21±6.70)years old;There were 18 males and 24 females.Fractures were classified according to AO/OTA: A1.2(6 cases),A1.3(16 cases),A2.2(8 cases),and A2.3(12cases).All proximal fractures were treated with sliding compression technique.Non-sliding pressure group(n = 34),age(75.76±5.73)years old;There were 18 males and 16 females.Fractures were classified according to AO/OTA: A1.2 in 5 cases,A1.3in 12 cases,A2.2 in 7 cases,and A2.3 in 10 cases.All proximal fractures were treated with routine treatment.Operation time,intraoperative blood loss,changes in femoral neck length immediately and 6 months after surgery,tip-apex distance change,fracture healing time,incidence of postoperative complications,and hip Harris function score were compared between the two groups at 1 year after surgery.Results:Follow-up data of 76 patients included in the study were complete,and the follow-up time was 12-18 months.There was no significant difference in gender,age,side,cause of injury,fracture type and other general information between the two groups(P > 0.05),and the data of the two groups were comparable;In 2 groups,the operative time [(54.81±6.60)min vs.(56.29±4.14)min],intraoperative blood loss[(117.38±23.07)ml vs.(122.35±21.89)ml],the change of femoral neck length immediately after surgery and 6 months after surgery [(2.39±0.56)mm vs.(2.17±0.52)mm],the change of apical distance [(1.67±0.75)mm vs.(1.94±0.89)mm],the Harris functional score of the hip joint at 1 year follow-up [(89.83±2.25)points vs.(87.35±10.61)points],there was no statistically significant difference(P > 0.05).In terms of postoperative complications,all patients in the sliding compression group had good wound healing,and no complications such as wound infection were observed.A total of 5 cases of visible nail withdrawal occurred,and clinical healing was achieved by sliding compression on the fracture end.Among them,1 patient had demything accompanied by screw cutting and hip inversion one month after the operation.After bed rest,the time of weight-bearing was delayed and the fracture healed.The patient could feel dull pain and discomfort on the lateral side of the hip in the resting state,and the hip pain worsened during weight-bearing activities,accompanied by claudication.One case was combined with dull pain and discomfort in the tail of the screw blade,which was considered to be caused by irritation of the tail of the screw to the surrounding soft tissues after the nail was removed,and was improved after symptomatic treatment such as analgesia.In the non-sliding compression group,there were no complications such as nail retreat and incision infection.There were 3 cases of screw cutting and hip varus.After bed rest,the time of weight-bearing was delayed and the fracture healed.The femoral head was cut out and penetrated into the acetabulum in1 case,resulting in hip dysfunction and pain and discomfort.Due to the poor physical condition of the patient,there was lack of opportunity for second revision and poor quality of life.The incidence of postoperative complications was 11.9%(5/42)in the sliding compression group and 11.8%(4/34)in the non-sliding compression group,and there was no significant difference between the two groups(x 2=0.000,P=0.985).However,the fracture healing time of sliding compression group [(6.79±0.81)weeks]was significantly shorter than that of non-sliding compression group [(7.88±1.07)weeks],and the difference was statistically significant(P < 0.05).Conclusion:Proximal femoral nail antirotation internal fixation should be applied to the treatment of senile intertrochanteric fractures.When anatomical reduction cannot be achieved,the medial cortex should strive to achieve positive supportive reduction,and the proximal application of sliding compression technology can significantly shorten the fracture healing time. |
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