To Compare With The Therapeutic Effect Of DHS Internal Fixation And Prosthetic Replacement For Intertrochanteric Fractures In Elderly Patients

Objective:To appraise the clinical results of the treatment of unstable interochanteric femoral fractures in the elderly with cemented bipolar hemi- arthroplasty by retrospectively comparing therapeutic effects and prognosis of management of intertrochanteric fractures in the elderly patients.Methods:Among the elderly patients of intertrochanteric fracture whom were treated in our hospital between March 2002 and December 2007, 30 cases are chosen randomly from prosthetic replacement group as"obse- rved group"and 40 cases of DHS group as"control group". All the patients were at an average age of 82.0 (ranged 71-102 years). 28 of 70 cases were male, 42 of 70 cases were female. The types of fractures were typed by Tronzo-Evans, which include 2 cases of type I, 13 cases of typeâ…¡, 29 cases of typeâ…¢, 25 cases of typeâ…£, 1 cases of type V. All cases would be graded by Harris standards after operation.Results:All cases are follow-up observed for 0.5-5 years. None infected. Analyzed by spss10, the operation time of DHS group was less than the prosthetic one with significant difference (P=0.035<0.05). The bleeding volume in DHS group was less than prosthetic group with significant difference (P=0.001<0.01), which can be used for further statics. For time of postoperative of weight-bearing, the observed group was earlier than that of control group, and there was a significant difference (P= 0.001 <0.01). When scored by Harris Standards, the Control group has an excellent rate of 87.5%, the fine rate for observed group is 90.0%, there was no significant difference (P=0.802>0.05).Through following-up to visit the groups of 40 patients who were with DHS inernal fixation , there were 14 cases after operation who had occured complications, such as deep venous thrombosis, lung infection, urinary tract infection, and so on,. which was amount to 35.0% of the groups.; Among 30 cases who have the operation of prosthetic replacement , 4 patients had occured those complication, amount to 13.3%; Which was analyzed by the software of spss10, there was a significant difference(P=0.04<0.05).1 pati- ents occured nonunion and 5 cases occured fixation failure in control group.2 of the 6 cases reoperated by prosthetic replacement.Observered group had not occured dislocation,prosthetic loosening,refractures,and no hip pain.Conclusions:Compared with DHS inernal fixation, the prosthetic replacement in the treatment of elderly unstable intertrochanteric fractures has a value in short-term therapeutic effects, which can allow patient to get out bed earlier for weight-bearing, and to recover with pre-injury activities earlier, which can reduce complication and improve the quality of life in patients. However, surgical indications should be strictly controlled.