Comparation Of Clinical Efficacy Of Two Internal Fixation To Treat Intertro-chanteric Fracture In The Elder Patients

Objective:To compare the clinical efficacy and postoperative complications of two internal fixation (dynamic hip screw and proximal femoral nail antirotation) to treat intertro-chanteric fracture, and to provide the basis of choosing the operation methods to treat intertrochanteric fracture in the elderly patients in clinic.Methods:56patients (age>65years old) with intertrochanteric fracture, who visited the orthopedics department of our hospital in January2008-December2011, were divided into Dynamic Hip Screw (D H S) Group and Proximal Femoral Nail Antirotation (P F N A) Group according to the operation method. The operation condition (including cut length of operation, duration of operation, times of X-ray exposure, and blood loss in operation), hospital stays (including hospital stays before operation, hospital stays after operation, and total hospital stays), time to full weight bearing, time to fracture healing, function of articulatio coxae and postoperative complications were compared in both groups.Results:(1) There were not significantly different in years old, gender, position of fracture, cause of fracture, Evans type of fracture, AO type of fracture, combined disease, and method of anesthesia in both group (P>0.05).(2) The cut length of operation and duration of operation in P F N A Group were significantly reduced compared to that in D H S Group (P<0.01); blood loss in operation in P F N A Group was significantly reduced compared to that in D H S Group (P<0.01), but times of X-ray exposure in P F N A Group was significantly reduced compared to that in D H S Group (P<0.01).(3) The hospital stays before operation in both group were not significantly different in statistic (P>0.05); but the hospital stays after operation and total hospital stays in P F N A Group were significantly shortened compared to those in D H S Group (P<0.01).(4) The time to full weight bearing and the time to fracture healing in P F N A Group were significantly shortened compared to those in D H S Group (P<0.01).(5) The excellent and good rates of articulatio coxae function were not significantly different in statistic (P>0.05).(6) There were no cases with cutting-out of screws, loss of neck shaft angle or looseness of internal fixation in P F N A Group, but they were all not significantly different in both group in statistic (P>0.05). The cases with coxa vara in P F N A Group and D H S Group were not significantly different in both group in statistic (P>0.05) There were no case with wound infection in both group in statistic (P>0.05). There were respectively7cases with postoperative complications in D H S Group and1cases with postoperative complications in P F N A Group, which were significantly different in both group in statistic (P<0.01)Conclusion:(1) Both internal fixation of D H S and P F N A have significant clinic efficacy to treat intertrochanteric fracture in elderly patients, but internal fixation of P F N A have less postoperative complications compared to internal fixation of D H S.(2) Internal fixation of P F N A has the advantage of easy operation, short duration of operation, and less blood loss, but has more exposure of X-ray in operation compared to internal fixation of D H S.(3) Internal fixation of P F N A has the advantage of short hospital stays and rapid recovery compared to internal fixation of D H S.(4) The time to full weight bearing and the time to fracture healing in patients treated by P F N A is significantly shortened compared to those in patients treated by D H S.