The Biomechanical And Clinical Curative Effects Of PCCP For Treatment Of Intertrochanteric Fractures: A Comparative Study

1. The biomechanical comparative study of DHS+Anti-rotation screw、PCCP for treatment of the intertrochanteric fracturesObjective: To study the biomechanical function of different internal fixations of theintertrochanteric fractures and to provide the scientific evidence of the valid fixingmethods for clinical choice.Methods: The14models of proximal femur were made into the intertrochantericfracture which were fixed with the following fixation devices: dynamic hip screw(DHS)+anti-rotation screw、percutaneous compression plate (PCCP).Then the differentinternal fixation methods were tested and proved by means of experiment press analysis.Results: The experiment press analysis proved that the biomechanical function ofPCCP was better than that of DHS in the following aspects(P<0.05）: load-strain,load-displacement, load-axial compression,,torsion moment-torsion angle and fixationfailure under static loading.Conclusion: It is a good way of the DHS and the PCCP to treat the intertrochantericfractures at present(except A3), which has the advantages of solid fixation and goodbiomechanical function.And the clinical practice tests its reality.The clinical applied study of DHS,PCCP and PFALP for treatment ofintertrochanteric fracturesObjective To compare the clinical effect of dynamic hip screw(DHS)andpercutaneous compression plate(PCCP)and proximal femoral anatomic locking plate(PFALP) which are extra-medullary fixations in the treatment of intertrochanteric fractures in the elderly patients.Methods From February2006to October2010,245old patients withintertrochanteric fractures were treated by either DHS, or PCCP or anatomic locking plate,including103males and142females with an average age of77.4±4.6years (60～99).According to AO/ASIF classification, there were116patients with type A1fractures,109for type A2and20for type A3. Totally136patients were treated with DHS,62with PCCPand47with anatomic locking plate. The three treatment groups were comparable in aspectof general data. The clinical data of surgical trauma, complications and postoperativefunction of the three groups were compared in our study.Results The patients included in the present study were followed up for6～36months(average23.4months). PCCP group had advantages in the length of incision, theoperation time, the intraoperative blood loss, the length of hospital stay, postoperativevisual analogue scale score and walking time which compared to the other two groups,with statistical difference among the3groups(P<0.05). Hospital charges in DHS groupwas cheaper than in other two groups, with statistical difference among threegroups(P<0.05). the time of fluoroscopy exposure in PCCP was longer than than in othertwo groups, with statistical difference among three groups(P<0.05). There were nosignificant difference in union time and the excellent rate one year postoperatively amongthe3groups.Conclusions Each of them has its own advantages, DHS is fit for stable fracturepatients with ASA level<Ⅱ. PCCP is fit for stable and unstable fracture patients with ASAlevel≥Ⅱ, and postoperative walking is earlier, recovering is better. Anatomic locking platecan be applied to the elderly patients with severe comminuted fracture and osteoporosis,and postoperative walking should be postponed.