Comparison Of The Curative Effect Of Three Ways To Treat Intertrochanteric Fractures

Intertrochanteric fracture means the fracture occurs between the base of femoral neck and smaller trochanter,which is one of the most traumatic diseases affects the elderly's health. The females'morbidity is higher than males'. There are some controversies about the therapy of intertrochanteric fracture in clinic all the time. Objective:To discuss the clinical effect of using artificially bipolar femoral head replacement,dynamic hip screws (DHS)and proximal femoral nails (PFN) to treat senile intertrochanteric fractures. Method:Sixty intertrochanteric fractures cases were retrospective analysed from November 2008 to July 2010 in the second hospital of JiLin University. The male patients were 25 and female patients were 35 (from 60 to 81 years old, mean age 71.5 years old). The reasons of injury:51 cases were caused by falling down when walking or standing,7 cases were caused by traffic accident,2 cases were caused by falling down from height. All intertrochanteric fractures were closed fractures. Modified Evans classification system was used for all the cases,7 cases in fractures typeⅠA,13 cases in typeⅠB,15 cases in typeⅡA, 16 cases in typeⅡB, 9 cases in typeⅢ. According to AO classification all were 31 A1-A2 type,20 cases in A1 and 40 cases in A2.25 cases were left fractures, 35 cases were right fractures and 0 cases were both in all patients. All patients were fresh fractures without important vascular and nerval damage. There were many underlying diseases, 7 cases were glycuresis, 17 cases were heart disease, 14 cases were hypertension and 42 cases were osteoporosis. The average time before operation was 12h～120h after injured. All patients were classified into three groups according to the therapeutic modalities,19 cases were treated with artificially bipolar femoral head replacement,21 cases were treated with dynamic hip screws, 20 cases were treated with proximal femoral nail. This study has compared the three types of treatment in terms of their surgery time, volume of operative bleeding, postoperative infection, prosthesis loosening,subsidence and dislocation, as well as postoperative recovery in treatment of elderly intertrochanteric fracture of femur,ect.Results:All 60 cases were followed up for an average of 8 months (range, 6 to 12 months). The results of three teams are as followed: surgery time of PFN is shorter (mean time 82.37 min ), volume of operative bleeding is lower(mean volume 185.49 ml) ( P<0.01 ).The average surgery time and average volume of operative bleeding were compared among three groups, which showed significant difference(P<0.01). Artificially bipolar femoral head replacement group was better than fixation group in terms of the time of bed and Harris hip function classification standard from 2 to 6 months after operation(P<0.01).Compared with early and late postoperative complications and assessment of knee function, which showed no significant difference(P<0.05).Conclusion:1)DHS belongs to side of plate fixation, which has been used extensively in clinic and achieved better clinical results. Because the local fixation of DHS are more intensively, lever arm relatively long, stress concentration can be happened easily. However, there is too much emphasis on firm fixed during surgical procedures, some complications are inevitably. For this reason, preoperative preparation should be fully achieved to understand the biomechanical characteristics of DHS, and standard operations in order to get good clinical results.2)PFN belongs to intramedullary class, which has biomechanical advantages than the side of the plate fixation [29-32].Compared with the other two PFN, it has shorter operation time and blood loss is lesser, which is a certain advantage for the treatment of senile femoral fractures; but reset of the medial femoral cortex is less effective and does not apply to accumulation of the greater trochanter and fractures were longitudinal splitting, so there are some limitations in clinical application.3)With the continuous improvement of prosthetic materials and maturation of artificial joint replacement surgery technology, artificially bipolar femoral head replacement in elderly patients with severe treatment of proximal femoral fractures show many advantages. Especially postoperative without interference of other underlying diseases, which could make the patients early out of bed. For other internal fixation surgery this is difficult to achieve. But the existence of prosthesis loosening, subsidence, dislocation, and postoperative renovation, etc. also happened. Especially if femoral fractures once occurs, which will make more harm to patients. There is cerebral vascular toxicity in the bone cement replacement, patients who have heart and cerebrovascular disease on this treatment should be carefully chosen.4)For intertrochanteric complex fractures, all the three treatments were applied to the modified EvansⅠ-Ⅲtype and AO classification of fractures are the 31A1-A2. But the treatment should be chosen carefully in terms of the injury mechanism, fracture type, extent of the damage around the blood supply, the hospital's medical standards, expectations, etc. Summing up all the conditions, artificially bipolar femoral head replacement are more likely to implement if requirements appropriately in all aspects.5)Postoperative functional exercises for the function of joint recovery is extremely important and should not be ignored.