A Comparison Of Different Methods In Treatment Of Femoral Intertrochanteric Fractures In Elderly Patients

BackgroundFracture of Femur Intertrochanteric is a common disease in clinical department of orthopedics. The incidence of this disease is increasing in recent years. According to the statistics, it accounts for 3.57% of the total fractures of the whole body, and accounts for 25% of the fractures of the extremities.The femoral intertrochanteric is rich in blood, and after fracture, such as proper treatment, the patient rarely does not heal the phenomenon. But due to the coarse intertrochanteric fractures are generally very unstable, coupled with higher average age of patients with hypertension, diabetes and other chronic diseases, poor body condition, for clinical treatment to bring certain difficulty. Intertrochanteric fracture was more common in elderly patients, due to the accelerated pace of aging in recent years, the incidence of the disease is increasing.At present, the clinical for elderly femoral coarse intertrochanteric fracture can take conservative treatment and surgical treatment in two ways, conservative treatment due to the fracture end was fixed, patients need to lie in bed for a long time, prone to deep vein thrombosis, urinary tract infection, pulmonary infection, bedsore and complications, more difficult.Surgical treatment is the commonly used in clinical treatment, mainly in the artificial femoral head replacement, external fixation, the locking compress plate, dynamic hip screw and proximal femoral nail/Proximal femoral nail Antirotation. But at present for the common surgery clinical curative effect of less.ObjectiveTo explore the differences in treatment of fracture patients in the therapeutic effect and complications between the senile intertrochanteric,In order to provide reference for clinical treatment options.MethodA study of 105 patients with femoral intertrochanteric fractures was made. They were treated with external fixator(23cases), Proximal Femoral Nail Antirotation(PFNA) (28cases),Dynamic hip screw(DHS,26cases), locking com press plat(LCP,28cases). Patients were followed up for 12 months, combined with Harries score of clinical effect of various treatments were analyzed.And further integration of bleeding volume, postoper-ative drainage volume indicators such as operation time, incision length, intraoperative compares every operation treatment.Result105 patients with fracture all healed, no patients died during hospitalization and follow-up. Comparison of the therapeutic effect index, The indicators were compared: incision length, operation time, intraoperative bleeding, postoperative drainage and bed time were significantly different(F=18.34,22.16,23.62,26.76,24.72,P<0.05)Multiple comparisons,The length of the cut:the PFNA group was better than the DHS group and the LCP group(P<0.05), but compared with the external fixation frame(P<0.05).The operation time:the external fixation group is superior to DHS and LCP (P<0.05), but longer than PFNA(P<0.05).There was no significant difference between PFNA group and external fixation group(P>0.05), but were superior to DHS group and LCP group(P<0.05).The bed time:there was no significant difference between PFNA group, DHS group and LCP group(P>0.05), but it was superior to external fixation group(P<0.05).Follow up for 12 months,The effect of treatment was evaluated by Harries score,The excellent rate in DHS group and LCP group were higher than those in external fixation group(P<0.05), but lower than that of PFNA group(P<0.05). The complications were observed after the treatment for each group.The incidence of complication in PFNA group was superior to that in external fixator group, DHS group and LCP group(X2=5.4059,4.5461,4.0816, P<0.05).There were no significant difference in the incidence of complications between the external fixation group, the DHS group and the LCP group(P>0.05).ConclusionTake the factors of operation effect, operation risk and surround operation period complications into comprehensive consideration,PFNA is the effective operation of intertrochanteric fracture of femur in the elderly with the advantages of minor trauma, better postoperative curative effect and fewer complications etc.