| Objective To analyze the clinical efficacy of proximal femoral nail – Inter TAN in the treatment of geriatric intertrochanteric fractures.Methods During Dec. 2008 to Jan. 2014, 531 patients with intertrochanteric fracture were treated in the First affiliated hospital of Dalian Medical University. Inclusive criteria is treated with Inter TAN(Smith-Nephew,Memphis TN), exclusion criteria is: younger than 60 years old when admitted to hospital, pathologic fracture, All living patients were followed up for more than 1 year. All fractures were classified by AO/OTA classification, cause of injury, complications, length of hospital stay, ASA grade, TAD, neck shaft angle, way of anesthetization, operative posture, operation time, hemoglobin level pre- and post-op, perioperative blood transfusion, post-operation complication, re-operation situation, femoral neck cripetura, defomral malunion, re-displacement, invalidity of internal fixators, hip fractures, hip joint varus, femoral neck necrosis, infection,cut-out and Harris score 、 SF-36 at 12 month follow up.Results 243 cases were included in the study, all of them were closed fractures. 127 of whom were applied general anesthesia,110 continuous epidural anesthesia and 6 with Combined spinal anesthesia. 232 cases got closed reduction, and 11 cases got open reduction. 169 cases got followed up, average follow-up time is(36.62 ± 16.94 months), 43 patients were dead while the last follow up. The average ASA grade(2.63 ± 0.6). The average operation time was(63.33 ± 30.92 minutes), average blood loss intaoperation was(112.22 ± 131.25ml). 54.32% of all the patients need transfusion, the average blood transfusion was(3.96 ± 5.27U). None intraoperative complication was seen. The average hospital stay was(12.38 ± 5.27 days). 18 patients suffered from complications during hospital stay, incidence rate was 7.4%, 7 cases of lung infection, 2 of them were dead. 5 cases of urinary system infection, 2 cases of pulmonary embolism,1 of them was dead. 1 hemorrhagic shock,and 1 case dead from 2 of infectious shock. 1 case of VTE. 1 year post-op mortality is 8.28%, 5 years mortality is 46.43%. 5 cases had the lag screw cut out, 2 of them got revision surgery of hip arthroplasty, 2 of them removed the Inter TAN without any fixation, 1 of them had adjusted the screw position. 1case suffered from femoral neck fracture, got hip arthroplasty. 1 lag screw had moved towards femoral head and inflating screw moved out, this case got screw-adjust surgery. 1 case got fat liquefying, the incision delayed union,and unioned after the revision surgery. Revision surgery rate was 5.33%.The average Harris score 12 months after operation was(78.32 ± 19.12), range from 25.7 – 100 score. Among the 38 cases scored as poor, 27 of them combined with severe disease leading to the bad walking ability. Of all the cases 50.79% recover the pre fracture walking ability. The SF-36 score 12 months after operation: the average PCs is(45.98 ± 9.94), range from 19.2 to 59.3, the average MCs is(54.41 ± 6.86),range from 32.4 to 64.9. There were significant differences between the Harris Score for the ASA grade(grade 1:96.56 vs grade 2:80.67 vs grade 3 :78.36 vs grade 4 :67.5).There were significant differences between the SF-36(PCs) for the ASA grade. There were no significant differences between the SF-36(MCs) for the ASA grade(P>0.05).Conclusion Inter TAN nail can treat intertrochanteric fractures with lower intra- and post-operation complications and can get ideal clinical efficacy. The efficacy and general condition of geriatric intertrochanteric fracture patients are associate with the severity of their combined disease pre-operativly. |
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