The Clinical Outcomes Of Treating Unstable Femoral Intertrochanteric Fractures In The Aged With Hip Arthroplasty And Proximol Femoral Anti-rotation Nail:a Comparative Study

Background&Objective:Femoral intertrochanteric fracture is one of the common fractures in the elderly.The elderly often have different degrees of osteoporosis.The common cause of injury is lowenergy injury such as falls.With the acceleration of population aging and the increase of the elderly population,the incidence of femoral intertrochanteric fracture has increased year by year.Old age is not a pathological condition,but the related functional reserve and compensatory ability to physiological stress state are significantly reduced.Old people often combined with one or more medical diseases,so higher requirements are put forward for the treatment of interrotational fracture in the elderly.This study aimed to compare hip arthroplasty(including artificial femoral head replacement and total hip arthroplasty)and proximal femoral nail antirotation(PFNA)of AO treatments for unstabal femoral intertrochanteric fracturtses of femur in the elderly.The advantages,disadvantages and curative effects of the two surgical methods were discussed to provide reference for selecting the indications of the two surgical methods in clinic.Methods:A total of 86 qualified patients were included in this retrospective study.According to different surgical procedures,all patients were divided in replacement group and proximal femoral nail anti-rotation fixation group(PFNA group),The replacement group included29 patients(3 patients in total hip arthroplasty,26 patients in hemiarthroplasty)and the PFNA group included 57 patients.Different clinical indexes including the duration of hospitalization,operative duration,total perioperative blood loss,intraoperative blood transfusion,bedridden time,postoperative complications,postoperative mortalityd.The recovery of hip joint was evaluated by Harris score in 3 months,6 months and 12 months after operation in the two groups by means of outpatient review,telephone call and door follow-up.Results:1.There are no statistically differences in age,sex,fracture classification(TronzoEvans classification)and preoprative complications were observed between the replacement group and the PFNA group(p> 0.05).2.Comparisons of operative indicators: Compared with the PFNA group,there was no significant difference in total perioperative blood loss and the operative duration between the replacement group and the PFNA group(p> 0.05);the intraoperative blood transfusion of the replacement group was higher in the perioperative period,and the bedridden time time and hospitalization time were significantly longer in the PFNA group.p<0.05).3.Comparisons of postoperative complications and mortality:There were 9 cases of short-term complications in replacement group(within 3 months after operation).There were 31 cases of short-term complications in PFNA group.The postoperative complications in the replacement group(within 3 months after operation)were lower than that in PFNA group.(p<0.05);There were 7 cases of long-term complications in replacement group(3-12 months after operation)and 15 cases of long-term complications in PFNA group.There were no significant differences in complications and mortality between these two groups 3months and 12 months after surgery(p>0.05).There were 3 deaths in short-term and 3deaths in long-term in the replacement group,8 short-term and 4 long-term deaths in the PFNA group.There was no significant difference in mortality between the two groups(p>0.05).4.The hip function of the replacement group was 46.76±18.12 points and the PFNA group was 29.44±12.87 points within 3 months after operation.Harris hip score in the replacement group were significantly higher than PFNA group(p<0.05).The hip function score of hip in 6 months after operation was 63.03±31.58 points in the replacement group and 47.23±25.84 points in the PFNA group.Harris hip score in the replacement group were significantly higher than PFNA group(p<0.05).The hip function score was replaced at 12 months after operation.The replacement group score was 68.66±36.74 points,and the PFNA group was 63.49± 34.83 points.There was no significant difference between the two groups(p>0.05).Conclusions:For elderly patients with unstable intertrochanteric fractures,hip arthroplasty is suitable for: elderly patients with poor general condition and multiple underlying diseases who cannot stay in bed for a long period of time;patients with severe hip osteoarthritis and avascular necrosis of femoral head before operation;unstable comminuted fractures of severe osteoporosis,patients with closed reset difficulty.PFNA internal fixation is applicable to patients with generalized or moderate to severe osteoporosis,type III fractures or type IV fractures with minimal displacement.