A Comparative Study Of The Clinic Effects In The Treatment Of Femoral Intertrochanteric Fracture With Two Intramedullary Fixation Device

ObjectiveTo compare the clinic effects of Short Reconstruction Intramedullary Nails andthe Proximal Femoral Nail Antirotation for Asian(PFNA-Ⅱ) in the treatment offemoral intertrochanteric fracture， and to provide reference for choosing the properinternal fixation method for femoral intertrochanteric fractures．MethodThe researchers chose their70research objects from the patients treated inDepartment of Orthopedic of the First Affiliated Hospital of Zhengzhou Universityfor the femoral intertrochanteric fracture in June2011to December2012, all of thesepatients were treated with Short Reconstruction Intramedullary Nails or the ProximalFemoral Nail Antirotation for Asian(PFNA-Ⅱ).These patients were all aged between53and83, they were divided into two different groups according to their treatmentmethod,32of them were treated with Short Reconstruction Intramedullary Nails, and38of them were treated with the Proximal Femoral Nail Antirotation for Asian(PFNA-Ⅱ).Their femoral intertrochanteric fracture were all fresh fractures,caused byinjury. From the following aspects of a comprehensive assessment of the clinicalefficacy of two internal fixation devices: the intraoperative blood loss, the operationtime, intraoperative fluoroscopy times, postoperative complications, fracture healingtime, hip joint function score (Harris Function Scoring Criteria), and so on. ResultsAfter operation，70cases were followed up from12to18months, and allpatients were no deaths during follow-up. Comparison of the two groups of patientswith intraoperative blood loss: the averaged intraoperative bleeding was126.3±57.7ml in the Short Reconstruction Intramedullary Nails group, the averagedintraoperative bleeding was84.2±52.4ml in the Proximal Femoral Nail Antirotationfor Asian(PFNA-Ⅱ) group, differences of intraoperative blood loss between the twogroups was statistically significant (P＜0.05）；Comparison of the two groups ofpatients with the operation time: the averaged operation time was68.8±15.2min in theShort Reconstruction Intramedullary Nails group, the averaged operation time was53.3±13.4min in the Proximal Femoral Nail Antirotation for Asian(PFNA-Ⅱ) group,differences of the operation time between the two groups was statistically significant（P＜0.05）；Comparison of the two groups of patients with the intraoperativefluoroscopy times: the averaged intraoperative fluoroscopy times was11.0±0.9in theShort Reconstruction Intramedullary Nails group, the averaged intraoperativefluoroscopy times was8.6±0.7in the Proximal Femoral Nail Antirotation forAsian(PFNA-Ⅱ) group, differences of the intraoperative fluoroscopy times betweenthe two groups was statistically significant（P＜0.05）；Comparison of the two groupsof patients with the postoperative complications: All patients with postoperativeincision were primary healing, All patients without pulmonary embolism, bedsore andnonunion. In the Short reconstruction intramedullary nail group,1patients happenedrespiratory tract infection,1patients happened urinary tract infection(they were curedafter the use of antibiotics), the proximal cross-bolting exit in1case, and all patientshad no deep vein thrombosis. In the Proximal Femoral Nail Antirotation forAsian(PFNA-Ⅱ) group,1patient happened respiratory tract infection,1case ofpatients came out lower limb venous thromboembolism, all patients without implantcutting、 implant loosening and hip varus. The incidence of postoperativecomplications in two internal fixation type was not statistically significant. Bothgroups were no significant differences in fracture healing time(P>O.05)；Harris HipScore between the two groups of patients was no significant difference before and6months after injury(P>0.05). Conclusions1. In the treatment of femoral intertrochanteric fracture with ShortReconstruction Intramedullary Nails and the Proximal Femoral Nail Antirotation forAsian(PFNA-Ⅱ), fracture healing time and postoperative functional recovery was nosignificant difference. All patients can be early postoperative weight-bearing exercise,decrease in long-term complications and reduce mortality.2. Application PFNA-Ⅱ relatively Short Reconstruction Intramedullary Nailscan reduce intraoperative fluoroscopy times, which can reduce radiation hazards forthe patients and the surgeons.3. Compared with Short Reconstruction Intramedullary Nails,The ProximalFemoral Nail Antirotation for Asian(PFNA-Ⅱ) has the advantages of shorteroperation time and less intraoperative blood loss; It can also reduce the Second hitcaused by surgery for patients. In addition，PFNA-Ⅱ can avoid the "Z" effect whichoccurred in the process of postoperative weight-bearing.