| Objective:To retrospective study the clinical effects of using artificial femoral head replacement and ITST Intertrochanteric Subtrochanteric Interamedullary Femoral fixation (ITST) to treat different types of intertrochanteric fracture in Elderly, evaluate the treatment effect of artificial femoral head replacement and ITST internal fixation in Different types of intertrochanteric fracture,to provide the reference for clinical rational selecting proper operation methods to different types of intertrochanteric fracture in elderly.Method:Select the patients who age≥80 years old with femoral intertrochanteric fracture and were admitted to Joint surgery ward of the fourth affiliated hospital of Guangxi Medical University from January 2011 to January 2014 as subjects. According to the inclusion criteria,Select 76 cases of eligible patients,These patients include 34 cases of men,42 cases of women,aged between80-101 years old, average of 86.3 years old, Depending on the type of fracture is stable or not divided into stable group of 36 cases and not stable group of 40 cases, Each group according to choose the different methods of operation are divided into two groups:in the stable group 19 cases with artificial femoral head replacement,17 cases with ITST internal fixation surgery; in the unstable group 22 cases with artificial femoral head replacement,18 cases with ITST internal fixation surgery; Collecting the following aspects in order to compare and analyze the mean operating time、intraoperative blood loss、the drainage after the operation、the time to ambulate with stick and without weight loading、the time of bear load、length of hospital stays、Harris hip scores of 1month、6 months and 12months after surgery、Postoperative complications within 1 year、fine/excellent rate among stable and unstable intertrochanteric fractures in elderly patients with artificial femoral head replacement and ITST internal fixation surgery respectively; Follow-up and timely record for selected patients,the ways of data collection include look up the illness records、 telephone follow-up、review of the records、on outpatient appointment and the door of follow-up,etc.Results:All the patients were obtained 12 to 32 months follow-up,mean 19.7 months.In the stable group, in the aspect of mean operation time、blood loss in the operation and drainage after the operation,ITST internal fixation is superior to femoral head replacement,two kinds of operation method had significant difference (P<0.05);two kinds of operation method were no statistical significance in terms of the time to ambulate with stick and without weight loading、length of hospital stays、Harris hip scores 6 months and 12months after surgery、Postoperative complications within 1 year、The rate of good function of hip joint after operation 1 year (P>0.05);in the aspect of Harris hip scores 1 month after surgery,femoral head replacement is superior to ITST internal fixation,in the aspect of the time of bear load,femoral head replacement is shorter than ITST internal fixation, had significant difference (P<0.05). In the unstable group, in the aspect of operation time and length of hospital stays,two kinds of operation method have no significant difference by statistical processing (P>0.05). In the aspect of blood loss in the operation and drainage after the operation,ITST internal fixation is superior to femoral head replacement,two kinds of operation method had significant difference (P<0.05);in the aspect of the time to ambulate with stick and without weight loading、the time of bear load、Harris hip scores 1 month after surgery,femoral head replacement is superior to ITST internal fixation,two kinds of operation method had significant difference (P<0.05);two kinds of operation method were no statistical significance in terms of Harris hip scores 6 months and 12months after surgery、The rate of good function of hip joint after operation 1 year (P>0.05),in the aspect of Postoperative complications within 1 year,the incidence rate of femoral head replacement is 9.09%,the ITST internal fixation is 16.67%,The difference between groups was statistically significant (P<0.05)Conclusions:1、For stable femoral intertrochanteric fractures [Ⅰa、I b of Evans) in elderly,femoral head replacement and ITST internal fixation both can achieve good clinical efficacy,but the Surgical trauma of femoral head replacement is bigger than ITST internal fixation.So for stable femoral intertrochanteric fractures, suggest to choose intramedullary fixation treatment.2、For unstable femoral intertrochanteric fractures (Ic、I d of Evans) in elderly, who With severe osteoporosis、With underlying diseases as well not suitable be long in bed, in the aspect of get out of bed in early、The hip joint function recovery and postoperative complications, femoral head replacement is superior to ITST internal fixation,which can make the patients early ambulation,resume the hip joint function before the injury as soon as possible,to reduce the bed time or else which can cause complications,then can improve the old patient’s quality of life,is an effective surgical method,but should Strictly grasp the operation indications. |
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