| Background: Early operation was the main treatment in the elderly patients withintertrochanteric fracture, but the weak elderly patients were difficult to endure for long timeoperation and blood, and there were more fixation failure risk in the patients with bonefragility. Dynamic hip screw (DHS) was the "gold standard" of treatment in intertrochantericfractures, but in recent years the new designed percutaneous compression plate (PCCP) andproximal femoral nail antirotation (PFNA) were gradually used in clinics. How to chooseinternal fixation and avoid fixation failure were the difficult problem for orthopedist.Objectives: To compare the clinical outcomes and trauma on treatment ofintertrochanteric fracture with PCCP, PFNA and DHS in elderly patients, and analyze theinfluence factors of fixation failure in elderly patients with intertrochanteric fracture. Itprovided the basis for the prevention of fixation failure and selection of fixation.Methods: Data of268patients, who had undergone surgical treatment with PCCP,PFNA and DHS from2005March to2012September in the department of orthopedics ofSouthwest Hospital, were retrospectively analyzed. There were111males and157females,aged from60to105years (average76.99years), included130cases in PCCP group,48cases in PFNA group,90cases in DHS group. We interviewed the patients by telephone,outpatient service review and cases et al. The operation time, incision length, obvious andhidden blood loss, decreased hemoglobin value, were analyzed comparatively; and thevalue of TAD, preoperative neck shaft angle, changes in neck shaft angles, Harris score,Parker-Palmer score, VAS score, the rate of fixation failure, and mortality were analyzedcomparatively at the last follow up. And logistic regression was used to assess risk factorsof failed internal fixation in the elderly intertrochanteric fractures.Results: A total of112patients were followed up for12to36months (average23.3months) in PCCP group,40patients were followed up for12to60months (average32.1 months) in PFNA group, and71patients were followed up for12to70months (average36.4months) in DHS group. There were less operation time, incision length, obvious bloodloss in PFNA group, but more hidden blood loss in group DHS (P<0.01). There were theleast operation time, postoperative HGB decreased value, obvious blood loss and hiddenblood loss, transfusion requirements，compared with PFNA group and DHS group (P<0.01).There were lower rate of postoperative HGB level <80g/L in the PCCP group, comparedwith PFNA group and DHS group (P<0.01). There were no difference in the averagehealing time (PCCP12.8VS. PFNA12.3VS. DHS14.5) weeks (P＞0.05). There werehigher rate of fixation failure in the DHS group, compared with PFNA group and PCCPgroup (P<0.01). There were no statistically significant in perioperative complications,1year mortality rate, and Harris score, Parker-Palmer score, VAS score at the last follow up(P＞0.05). There were higher value of TAD and change of neck shaft angles above10°inDHS group at the last follow up, compared with PFNA group and PCCP group (P<0.01).There were no statistically significant in value of TAD and change of neck shaft anglesabove10°between PCCP group and PFNA group at the last follow up (P＞0.05). Thescrew position (p=0.038, risk:7.393,95%confidence interval1.119to48.849),postoperative change of neck shaft angles (p=0.020, risk:5.758,95%confidence interval1.319to25.128), fracture type (p=0.010, risk:10.593,95%confidence interval0.639to175.663) were risk factor of fixation failure in the elderly intertrochanteric fractures.Conclusion: The operative trauma of PCCP was less than PFNA and DHS, theoperative trauma of PFNA was the same as DHS, there were higher transfusionrequirements,the rate of postoperative HGB level <80g/L in PCCP and DHS. There washigher rate of fixation failure for DHS operation, PCCP and PFNA were ideal internalfixation, which obtained good clinical effects in intertrochanteric fractures, There weremore advantage in operation time, postoperative HGB decreased value, obvious and hiddenblood loss, transfusion requirements for PCCP. in addition, Screw position worse, big neckshaft angles changes, unstable fracture were risk factors of internal fixation failure. Goodfracture reduction and screw position is the key for operation. |
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