| Objective:With the extension of human life, China’s population aging, the incidence of hip fractures also presents the trend of increasing year by year. Because of the elderly often associated with age-related neurological disorders, the characteristics of poor balance and protection ability is poor, resulting in the elderly often appear fracture accident injury. Intertrochanteric fracture for the elderly hip fracture in areas of high incidence of hip fracture, the proportion of about 31-51%, often by falling injury. Plus the older body of wound repair ability is poor, the hip joint muscle strength is abate,bone loss, osteoporosis, often associated with other underlying disease mortality in Department of internal medicine, can be as high as 15- 20%. At present, according to the operation is the first choice of treatment for intertrochanteric fracture in the senile,but the operation methods, and not a fixed, uniform standard to follow. This article selects the current clinically used in the treatment of elderly patients with osteoporotic intertrochanteric fracture in two kinds of operation mode(i.e. PFNA and artificial joint replacement), carries on the analysis, through the discussion of the clinical treatment effect of 2 kinds of operation mode of fracture in the treatment of senile osteoporotic intertrochanteric, summarizes its advantages and disadvantages, and to provide reference for selection of operation the broad masses of medical workers in the treatment of senile osteoporotic fracture between rotor and stator on.Method:A retrospective statistical analysis, the Second Affiliated Hospital of Dalian Medical University from 2013 March--2015 year during March, admitted to the Department of orthopedics, selected 72 cases treated by operation in the elderly patients with intertrochanteric fracture, according to the different operation mode is divided into PFNA group and artificial hip joint replacement group. Group PFNA: 20 cases of 16 cases of male, female, age 75-92 years old, mean age 82.4 + 5.5 years; Evans type I 1cases, type II 3 cases, type III 16 cases, type IV 12 cases, V(reverse intertrochanteric fracture 4 cases). Before operation, 9 cases complicated with cardiovascular and cerebrovascular diseases, 3 cases of digestive system diseases, 6 patients with respiratory system diseases, 2 cases of urinary system disease, 4 cases of endocrine system diseases, 2 patients with other system diseases. Artificial joint replacement group: male 17 cases, female 19 cases, age 76-94 years old, mean age 84.7 + 5.4 years;Evans type I 1 cases, type II 7 cases, type III 14 cases, type IV 10 cases, type V(reverse intertrochanteric fractures of 4 cases). Before operation, 10 cases complicated with cardiovascular and cerebrovascular diseases, 2 cases of digestive system diseases, 8cases of respiratory system disease, 5 cases of endocrine system diseases, 5 patients with other system diseases. The two groups preoperatively with active treatment of underlying diseases corrected to normal with operation conditions. 2 groups were respectively on the general condition of patients, intraoperative bleeding, operation time,intraoperative and postoperative blood transfusion passengers, postoperative weight-bearing time and average hospitalization days, cost of treatment, postoperative complications and hip joint after operation in January, March, August and December Harris score analysis comparison and summary.Results: Based on all the patients were followed up for 6-24 months, gender, age,fracture type, with general information department of internal medicine disease data analysis, comparison of the two groups of patients, no statistically significant differences between the comparative analysis, between the 2 groups(P>0.05).Operation time of about 50.1 + 23.2min in PFNA group, amount of bleeding during the operation of about 192.4- 41.5 ml, intraoperative and postoperative blood transfusion of7 people, accounting for 19.4%, the average load time of 12.2 + 3.3 days, the total cost of treatment was 35661.4 + 1326.1 yuan, average hospitalization days was 9.13 + 4.62days; operation time of about 77.3 + 16.1min joint replacement group, amount of bleeding during the operation of about 310.4- 78.3 ml, intraoperative and postoperative blood transfusion 19 people, accounted for 52.8%%, average load time of 5.81 plus or minus 1.3 days, the total cost of treatment 48225.8- 1964.3 yuan, the average hospital stay was 11.46 + 7.7 days. PFNA group in the operation time, blood transfusion after operation, the number of bleeding in the operation and the treatment cost is obviously lower than arthroplasty group; but earlier than the PFNA group under weight-bearing activities in the arthroplasty group, differences between the 2 groups were statistically significant(P<0.05); the 2 groups of patients the average hospitalization time basic quite, no statistical significance(P>0.05). After the surgery related complications in the2 groups no statistically difference(P>0.05); the 2 group the postoperative Harris hip function score: 1 months after surgery: group PFNA was 58.4 + 8.7, hip joint replacement group is 65.5 + 9.6, the difference was statistically significant(P<0.05);after March: PFNA group 69.1 + 9.3, joint replacement group is 74.6 + 11.7, the difference was statistically significant(P<0.05). 8 months after surgery: group PFNA was 78.8 + 10.1, joint replacement group is 81.3 + 9.4, no statistically significant difference between the two groups(P>0.05), 1 years after surgery: group PFNA was85.2 + 10.6, hip joint replacement group is 73.3 + 9.8, the difference between the 2statistically significant(P<0.05). That the hip joint function in June 1, after joint replacement was significantly better in the PFNA group, the postoperative hip joint function of 2 groups after 8 months of no difference, but after 1 years of group PFNA of the hip joint function recovered better.Conclusion: PFNA intramedullary fixation and artificial joint replacement is effective operation modes of clinical at present the treatment of senile osteoporotic intertrochanteric fracture, have their own characteristics of two kinds of operation method in the treatment of. PFNA fixed fundamentally restore the integrity of the limb of biology, the long-term recovery of joint function is stronger, the operation is simple,small operation wound, bleeding volume, operation time is short, small forward hip joint function and economy than arthroplasty group. Is the preferred surgical treatment of intertrochanteric fracture. Artificial joint replacement can provide early good stability for patients undergoing hip, can make the patients were out of bed early weight-bearing activities, effectively reduce the occurrence of complications, more suitable for osteoporosis serious unstable, patients were evaluated for internal fixation operation failure expected survival time, fracture healing, high difficulty and poor general conditions needs early ambulation of less than 5 years old fracture has the advantage of.So in response to the patient’s age, preoperative body of operation tolerance, fracture type, the general situation of effective evaluation, according to the individual differences in selection of the operation mode, the patient can better and faster recovery,reduce the pain of patients, ensuring a better quality of life. |
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