Clincal Research And Indications Of DHS And PFN Interfixation In Treatment Of Senile Femoral Intertrochanteric Fractures

Objective To analyse the curative effects and indication of DHS(Dina mic Hip Serew)and PFN(Proximal Femoral Nail) in treating intertrochanteric fractures.Information and Method 1.General information:collected 131 patients of intertrochanteric fractures who had been hospitalized and operationed by DHS or PFN fixation in our hospital and the 2nd Clinical hospital of JiLi n University,all cases were divided into two groups in random,the fracture of group DHS is 50 cases which were collected in the 2nd Clinical hospital of JiLin University,there were 25 males and 25 females with average ag e of 60.3 years.Evans classification system was used for all the cases,14 cases in fractures typeⅠ,13 cases in typeⅡ,13 cases in typeⅢ,10 case s in typeⅣ,0 cases in typeⅤ.There were injuries by falling down in 40 cases,injuries by car accident in 10 cases,normal in 5 cases,osteopeni a in 20 cases,osteoporosis in 25 cases,combined with injuries of pulmona ry function insufficient in 9 cases,hypertension in 11 cases,heart disease in 10 cases,diabetes in 11cases,nervous system disease in 6 cases,incorporat ion with two or more disease above-mentioned in 11 cases.The fracture of group PFN is 81 cases,there were 37 males and 44 females with average age of 58.5 years,Evans fractures typeⅠin 28 cases,typeⅡin 20 cases, typeⅢin 22 cases,typeⅣin 8 cases,typeⅤin 3 cases.There were injuri es by falling down in 71 cases,injuries by car accident in 10 cases,normaⅠin 5 cases,osteopenia in 38 cases,osteoporosis in 38 cases,incorporation with pulmonary function insufficient in 5 cases,hypertension in 26 cases,he art disease in 6 cases,diabetes in 18 cases,nervous system disease in 4ca ses,incorporation with two or more disease above-mentioned in 19 cases.Result All cases were followed up,the follow-up period was ranging fr om 6 months to 2.5 years,2 years on average.There was no complicatio n in all cases of two groups during operation internal fixation.Rechecked b y shooting x-ray in post-operation,it found fracture replacement was good,int ernal fixation was firm.None of patients occurred internal fixtion falure or unl oaded the internal fixtion object for infection,hip joint pain,functional distur bance etc.The fracture have bone union after one year of post-operation thr ough X-ray.No one occurred femoral head necrosis and other complications, all patients returned to normal orthobiosis.According to curative effective eva luation referrence,the curative effects of internal fixtion in 131 cases reach ed to fineness.In the group DHS,the average time of operation was 80.4 mi n,the average blood loss during operation was 433.5 ml,the average blood t ransfusion during operation was 486.9 ml,the average length of incision wa s 12.3 cm,the average draining of post operation was 82.4 ml;In the group PFN,the average time of operation was 51 min,the average blood loss duri ng operation was 66.7 ml,no one was gove blood transfusion during opera tion,the average length of incision was 6.1 cm,the average draining of post operation was 45.8 ml.We can find the group PFN was optima in the oper ation time,the blood loss during operation,the length on incision and the draining.There were 2 cases occurred the internal fixtion objective cinch an d cutting in group DHS,contrast to group PFN,which showed no significant difference(P＞0.05).There were 8 cases about epiphyseal coxa vara in gro up DHS,while 3 cases in group PFN,which showed significant difference(P＜0.05),this showed the group PFN is better than the group DHS in compli cation epiphyseal coxa vara.the fineness rate was 80%in group DHS while 90%in PFN,which showed significant difference(P＜0.05).The use of Harri s's classification for hip joint function based on Post operation one year a chive excellent,the mean scores in the group DHS was average 88.75 scor es while 87.12 scores in the group PFN,the mean time of accrete was 12. 6 months while 10.6 months in the group PFN;the mean extremity decurtati on was 1.6cm in the group DHS while 0.6cm in the group PFN,which show ed no significant difference(P＞0.05)in the functional scores while showed sig nificant difference(P＜0.05)in the complication of extremitydecurtation.It was similar to age,bone mass and the classification of fractures.This showed t hat age has no effect on modus op[erandi;the post operation fineness was. badly in osteoporosis patients,and PHN was well fit the osteoporosis patient s;we also find that DHS was excellent in treating Evans typeⅠandⅡwhile PFN was excellent in treating Enans typeⅢandⅣ,which showed no signi ficant differance(P＞0.05).Conclusions 1.It is a good way with DHS or PFN internal fixation to treat the femoral intertrochanteric fractures,but we should strictly handle th e operation indications.2.DHS has no significant difference in the operation t ime,the blood loss during operation,the blood transfusion during operation, the draining in post operation and the time of the union of fracture;PFN h as no significant difference in the time of the union of fracture compare wit h DHS while has significant difference in the operation time,the blood loss during operation,the blood transfusion during operation,the draining post o peration.3.DHS and PFN have no significant difference in the union joint aft er one year of post operation(P＞0.05).4.PFN have excellent in operation on DHS,especially in treating osteoporosis and Evans typeⅢandⅣ.