Correlation Analysis Between Bone Mineral Density And The Curative Effect Of Aged Intertrochanteric Fracture

[objective]Investigate the correlation analysis between preoperative bone mineral density and the curative effect of aged intertrochanteric fracture fixation, so as to make the curative effect after aged intertrochanteric fracture fixation better.[method]The research analyzed aged intertrochanteric fractures patients retrospectively from May 2012 to May 2014 at Yan’an University Affiliated Hospital Orthopedics ward. After admission, dual-energy X-ray absorptiometry for all hospitalized patients’ uninjured side femur(including the femoral neck, Ward’s area, trochanter)BMD determination before operation, and all underwent DHS fixation. Evaluate the function of hip joint by Harris score, research the sixth month’s result followed up. Compare sex, combined disease before injury, and classification of fracture between two different curative effects’ groups by chi-square test or Fisher exact proability statistical method. Compare BMD and age between two different curative effects’ groups by t-test statistical method, and compare BMD between two different classifications of fracture groups by t-test statistical method. The difference between these two groups were statistically significantly(P <0.05). Through the analysis to find factors that may lead to adverse effect of dynamic hip screw fixation, and provide a useful reference for the development of intertrochanteric fracture treatment.[results]All the patients were followed up for 6-12 months, six cases of adverse effect in the patients after internal fixation. Good curative effect group mean BMD is(642 ± 24.87)mg / cm2, the effect of adverse group mean BMD is(513 ± 60.49) mg /cm2, That showed BMD values between the two groups was statistically different(P=0.003<0.05); in the stable fracture group, good curative effect group mean BMD is(647±27.89) mg / cm2, the effect of adverse group mean BMD is(515±3.48) mg /cm2, That showed BMD values between the two groups was statistically different(P=0.000<0.05); in the unstable fracture group, good curative effect group mean BMD is(638±4.53) mg / cm2, the effect of adverse group mean BMD is(511±0.87) mg /cm2, That showed BMD values between the two groups was statistically different(P=0.000<0.05);stable fracture group’ rate of curative effect was 97.73%, unstable fracture group’ rate of curative effect was 76.19%, indicating the rate of curative effect between the different types of fractures was statistically different(P = 0.019 <0.05); internal fixation efficacy rates of male and female groups are not statistically different( P = 0.817> 0.05); internal fixation efficacy rates among different combined diseases groups are not statistically different(P= 0.752> 0.05); the good curative effect group’ mean age is(74.92 ± 6.19) years, the bad curative effect group’ mean age is(76.17 ± 7.76) years old, indicating that there is no statistical difference between the age of both groups(P = 0.646> 0.05). Stable fracture patients’ contralateral hip mean bone mineral density is(625 ± 36.48) mg/cm2, unstable fractures patients’ contralateral hip mean bone mineral density is(624 ± 3.89) mg/cm2, there is no statistical difference between the BMD of both groups(P= 0.922> 0.05).[conclusion]BMD and fracture type are fixed factors about curative efficacy after aged intertrochanteric fracture by DHS internal fixation.The lower the BMD, the worse the effect of internal fixation. Unstable fractures’(Tronzo-Evans Ⅲtype, Ⅳtype) curative effect is worse than stable fractures’(Tronzo-Evans Ⅰtype, type). About the relation Ⅱof bone mineral density and fracture type, this study has found no statistical correlation. The results of this study suggest that not only rely on the type of fracture, but do the preoperative bone density testing, evaluating degree of osteoporosis through bone mineral density measured by dual-energy X-ray absorptiometry and fracture stabilitythrough Evans classification comprehensively, can effectively develop appropriate internal fixation surgery program. For higher BMD values, stable or unstable fracture(Tronzo-Evans Ⅲ type, Ⅳ type), DHS internal fixation is applicable; for lower BMD values,stable or unstable fracture(Tronzo-Evans Ⅲ type, Ⅳ type), should make a better curative effect, if choose intrameduallary internal fixation or arthroplasty, DHS is not suitable.