Clinical Application Of Anterolateral Muscle Sparing Approach In Treatment Of Intertrochanteric Fracture Of Femur

Objective：To compare curative effect and functional recovery between anterolateralmuscle sparing approach and conventional lateral approach in treatment ofintertrochanteric fracture of femur.Methods：From December2010to December2012，61patients with intertrochantericfracture was prospectively analyzed. Of61patients,34patients underwentIntermuscular space approach combined with fixation of dynamic hip screw(trialgroup)，27patients underwent conventional lateral approach combined with fixationof dynamic hip screw(control group). There was no significant difference in age，gender, Evans classification, injury cause,comorbidities, disease duration and Harriship scores between2groups (P>0.05).Results：The operation was successfully completed in all patients. The operation time,blood loss, perspective frequency during operation, drainage volume, hospitalizationdays, and out-of-bed time in the trial group be significantly superior to those in thecontrol group (P<0.05)，except length of incision. All patients were followed up12-24months (mean,18.7months). Bone union was achieved in both groups, the fracturehealing time was (11.64±1.28) weeks in the trial group and was (12.29±1.12)weeks in the control group, showing no significant difference (t=2.15, P=0.15).Harris hip scores at3,6, and12months were significantly better than preoperativescores in2groups (P <0.05), and significant differences were found among differenttime points after operation in2groups (P<0.05),between2groups after operation(P<0.05). There was no significant difference in the incidence of incision infection,limb shortening, coax vara, internal fixation loosening, main screw cutting-out fromfemoral head between2groups (P>0.05), but the incidence of total complications inthe trial group was significantly lower than that in the control group(P<0.05). Theconcentration of C-reative protein and creatine kinase at various time points afteroperation were significantly higher than before operation in2group, and nosignificant difference were found in the range of concentration variation amongdifferent time points after operation between2groups(P>0.05). Conculsion：Compared with conventional lateral approach, improved anterolateralapproach has the advantages of sufficient exposure, reducing surgical risk in treatingintertrochanteric fracture. Operating treatment of anterolateral muscle sparingapproach combined with early rehabilitation after surgery can recover hip jointfunction as quickly as possible.