A Comparative Study Of The Efficacy Of Treatment With Intramedullary Fixation, Extramedullary Fixation And Artificial Joint Replacement Surgery For Intertrochanteric Fracture Of The Oldest Old

[Objective] To the clinical efficacy of treatment with Intramedullary fixation, extramedullary fixation and artificial joint replacement surgery for intertrochanteric fracture of the oldest old, providing clinical evidence for the treatment of elderly intertrochanteric fractures. [Method] Prospective randomized study. Statistical comparison on surgical bleeding, time and postoperative complications of Intramedullary fixation, external fixation and artificial joint replacement (mainly bipolar artificial femoral head replacemen), surgical incision size, postoperative full weight bearing time of the affected limb, bedridden time, length of hospital stay, hip function, intraoperative fluoroscopy times were operated. The patients were followed up 14 days,3 months, and 9 months after surgery. And there was statistically significant (P<0.05) using SPSS software to analysis. [Results] Follow-up period rang from two months to three years, an average of 12 months. Intramedullary nailing, extramedullary fixation, artificial joint replacement surgery could successfully complete. The surgical time of artificial joint replacement surgery and intramedullary fixation time was short, while extramedullary fixation was longer. There are significant differences (P<0.05) in three surgical operation time; bipolar artificial femoral head replacement bleeding the most with the largest surgery incision. But the intramedullary fixation surgery bleed less with a smaller incision. The pairwise comparisons on surgical blood loss, surgical incision of the three was statistically significant(P<0.05). Intraoperative and postoperative complications of three surgical methods were no statistically significant. Artificial bipolar femoral head replacement surgery had less fluoroscopy times. The affected limb could bear the full weight after five days with less bedridden time and shorter hospital stay, getting a good hip function after three months after surgery. Compared with intramedullary and extramedullary fixation, there were significant differences(P<0.05). While compared extramedullary fixation with intramedullary one, fully weight-bearing time of the affected limb with intramedullary fixation was shorter, but poor hip function was found after 14 days and three months of postoperative follow-up (P<0.05). In the artificial bipolar femoral head replacement surgery, intramedullary nail group and extramedullary fixation group after nine months, there were respectively 27,25 and 23 cases being followed up. All^ patients of intramedullary fixation, extramedullary fixation, arthroplasty groups gained a good hip function without statistical significance (P>0.05). [Conclusion] Artificial bipolar femoral head replacement surgery, intramedullary fixation, extramedullary fixation for intertrochanteric fractures in the elderly old had achieved good results, with less intraoperative and postoperative complications. The surgery time, bedridden time, hospital stay time of bipolar femoral head replacement surgery group were shorter, and got instant good joint function after surgery. What's more, the patient could bear the full weight using the affected limb after one week, achieved early ambulation and reduced nursing difficulties, significantly improving the quality of life. Thus it is a safe, suitable surgery for intertrochanteric fractures in the elderly old, being worthy of promotion.