Clinical Efficacy Of Intertrochanteric Fractures Of Different Surgical Treatment

Backgrounds: intertrochanteric fracture is a common type of fracture inthe elderly, because of the rich blood supply around the hip there wasrarely nonunion existence, for its specific anatomical location, located inthe lower extremities junction conductance line, prone to conservativetreatment varus deformity and complications of prolonged bed rest, it isadvocated aggressive surgical treatment by rigid fixation, allowing earlyfunctional exercise, reduce the occurrence of varus deformity of the hip.Intertrochanteric fracture surgery is varied, experienced mainlyintramedullary fixation and extramedullary fixation in two ways.Extramedullary fixation typical of dynamic hip screw in treatment ofintertrochanteric fractures good results, fracture healing rate and fewercomplications. With the continuous development of intramedullaryfixation, intramedullary system show a more excellent effect and lowercomplications. Intramedullary fixation and extramedullary fixation in thetreatment of intertrochanteric fractures aspects have similarities, there arealso all sorts of differences, and each of which has its owncharacteristics. Objective: To observe the intramedullary fixation and extramedullaryfixation mechanism of the system itself, comparing various surgical riskand outcome measures, and to explore the advantages and disadvantagesof various surgical treatment of intertrochanteric fractures, make analysisof their respective scope and precautions, for the treatment ofintertrochanteric fractures provide a theoretical basis for the choice ofsurgical approach, providing reference and guidance in the surgicalprocedure.Methods: A retrospective analysis of the china-japan union hospital ofJilin University Orthopaedics2010-2013intertrochanteric fractures weretreated99cases, male58cases, female41cases, according to the AOclassification, A1-type25cases, A2type51cases, A323cases. Wereselected DHS, GAMMA3, INTERTAN three different surgical methods.Which GAMMA3group of43patients,26males and17females, A18cases, A2type26cases, A3type9.26cases INTERTAN group,14males and12females, A16cases, A212cases, A38cases. DHS groupof30cases,18males and12females, A1-type11cases, A213cases,A36cases. Extramedullary fixation using the supine position,intramedullary fixation group of patients in traction fixed bed, closedreduction under fluoroscopy. The patients in each group ’s age, genderand fracture type for statistical analysis, no significant difference. Threegroups using the same preparation and anesthesia before surgery. Statistics for each group of patients operative time, blood loss, woundhealing, fracture healing time, postoperative hip score, postoperativecomplications and other indicators, data analysis, observed the indicatorsof whether a significant difference.Results: The three groups of patients was followed of4to13months,all fractures was healed,the incision healing time was12day in externalfixation group, intramedullary fixation group9days. Stability in theoperation time GAMMA3group55.4±7.5min, INTERTAN group64.5±10.2min, compared to77.4±10.4min DHS group, each group (P <0.05,the difference is statistically significant. Unstable operation timeGAMMA3group64.3±7.1min,77.8±6.7min INTERTAN group,compared to97.8±8.7min DHS group, each group (p <0.05, thedifference was statistically significant. Stable intraoperatie blood lossGAMMA3group178.9±25.7ml, INTERTAN group205.0±30.3ml,DHS group270.1±37.1ml, intramedullary and medullary group contrast P<0.05, the difference is statistically significant, intramedullary contrasthas no statistical significance between groups. Unstable intraoperatieblood loss GAMMA3group209.7±34.3ml, INTERTAN group220.0±17.5ml, DHS group313.1±28.7ml, intramedullary and medullarygroup contrast p <0.05, the difference was statistically significant,intramedullary contrast between groups, p>0.05, the difference is notsignificant.Postoperative Harris scoring GAMMA3group was88.9%, the stability of fracture INTERTAN group was90.0%, the DHS group was78.6%, through the statistical analysis, P>0.05, there was no statisticallysignificant difference in three groups. In unstable fractures, GAMMA3group was85.3%, INTERTAN group was87.5%, the DHS group was56.3%, after statistics analysis, GAMMA3and INTERTAN group washigher than that of DHS group, there is statistical significance, its contrastthe difference between the two groups have no statistical significance.Conclusions: the three kinds of stable operation method in the treatmentof intertrochanteric fracture effect is obvious, successful healing fracturesare, in the unstable fracture treatment, DHS internal fixation failure rate ishigh, intramedullary fixation effect is good, GAMMA3shorter operationtime, suitable for patients with poor tolerance, INTERTAN has bettercompression effect and stability, is suitable for patients with comminutedfracture and osteoporosis.