Comparison Among Three Methods Of Treatment For Intertrochanteric Fractures

Objective: Through the summary and analysis about the clinical data andfollow-up results of dynamic hip screw (DHS),proximal femoral nail antirotation（PFNA)and artificial fernord head arthroplasty (hemiarthroplasty)in the treatmentof intertrochanteric fractures of the elderly, with the discussion of reasonable methodsof treatment for aged intertrochanteric fracture, the paper provide clinical evidence ofrational treatment of intertrochanteric fractures.Methods: A retrospective study on the patients of our hospital with completeinformation from June2004to june2010is carried out.131patients withintertrochanteric fractures were treated,72patients were treated by Dynamic hipscrew(DHS),43patients by Proximal femoral nail antirotation （PFNA) and16byartificial fernord head arthroplasty (hemiarthroplasty).All patients were60-92yearsold and were followed up from6months to3years to fracture healing. The threegroups of patients were statistically analyzed and compared with surgical trauma,postoperative recovery and complicationsResults: In surgical trauma, DHS resuled in the longest operation time, themost blood loss; PFNA resuled in the shortest operation time, the least bleedingvolume; and the hemiarthroplasty was in the middle.There is no significant differencein postoperative drainage between the hemiarthroplasty and the DHS,however,it ismore than PFNA. Length of incision in DHS was the longest and PFNA theshortest. the number of X-ray exposure in PFNA was the most, DHS the least. As toPostoperative recovery, the excellent and good rate between DHS group, semi-hipreplacement group and PFNA was no significantly different with multiple samplerates of multiple comparisons; semi-hip replacement was the shortest group innon-weight-bearing walking time, hospitalization time and healing time, DHS groupwas more than PFNA group in the field; the recovery of joint function of semi-hip replacement group was more quickly than that of DHS group and PFNA group, therewere not significant differences between DHS groups and PFNA group. Inpostoperative complications, the incidence of DHS group was higher than that ofPFNA group, but there were no significant difference between semi-hip replacementgroup and PFNA group, and there were no significant difference between semi-hipreplacement group and DHS group. the specific long-term complications ofsemi-hip replacement group need to be further followed up.Conclusion: PFNA which has more advantages of rigid fixation, less surgicaltrauma, rapid postoperative recovery, and low chance of complications than DHS, ispreperred in the treatment of senile intertrochanteric fractures. But PFNA demandsskilled surgical procedures, need X-ray more exposure. DHS fixation is simple,affordable, and more suitable for primary hospital; DHS fixation are also recommended for AI-type fracture and the fracture near the entry point of PFNA. Thehemiarthroplasty, which compared with PFNA and DHS fixation,has higher successrate, shorter time away from the bed, more significant outcome, therefore, it is one ofthe best way to treat unstable comminuted and/or severe osteoporosis of elderlyintertrochanteric fracture. However, if the use of DHS and PFNA also can achievesatisfactory results, the use of The hemiarthroplastyi isn’ t generally considered...