| Objective: It is a high incidence of intertrochanteric fractures,which influence old people's physical health seriously.Because of a long time in bed?much complications and high morbidity for the conservative treatment,we always take surgery now.However,there is controversial for the best surgical treatment of elderly fracture,at present,we commonly used is closed reduction PFNA internal fixation and the artificial joint replacement.To compare the clinical curative effect of PFNA Internal fixations and double acting femoral head replacementof unstable intertrochanteric fractures in the elderly,to explore reasonable operation scheme for senile unstable intertrochanteric fractures.Methods: 51 cases of patients over the age of 75 unstable intertrochanteric fractures between October 2013 to February 2016 were divided into PFNA internal fixation group and joint replacement group.PFNA internal fixation group has 26 cases and joint replacement group has 25 patients,two groups of operation performer and first assistant are all the same.Observing operation time for two groups of patients with surgery,hidden blood loss(3 days after postoperative),early postoperative complications(3 months after postoperative),and according to the Harris evaluation criteria,evaluating postoperative recovery of two groups,which is divided into optimal of 90~100 points,good of 80~89 points,middle of 70~79 points,poor of 70 points.we took the follow-up of two groups for 15.2 months and 16.1 months respectively,and calculate the excellent rate?statistical inspection of internal fixation group and the joint replacement group.All data using SPSS 21.0 statistical software analysis,The data of the research was expressed as mean((?)±2s),95% confidence interval was set to((?)±2s).T-test and ?2?test were used for the comparisons of fetuses,which have the same quantity and gestational age but with different sex.Difference was statistically significant at P<0.05.Results: Internal fixation group operating time averaged 51.38 ? 10.08 minutes,joint replacement group was 72.01 ? 10.23 minutes,there was a significant difference compared with the two groups(P = 0.00);Internal fixation group of hidden blood loss,(3 days after postoperative)was 708.85 ?121.40 ml,joint replacement group was 918.00 ? 154.24 ml.There was a significant difference compared with the two groups(P = 0.00);Internal fixation group within 3 months after surgery had 1 case of subcutaneous fat liquefaction,1 cases with skin necrosis,after giving debridement,incision were healed.2 cases with hip varus deformity,2 cases with delayed healing of fracture,all fractures healed when followed up for 12 months,and the average healing time was 3.5 months.Joint replacement group wound healing is good,but 1 case of a joint dislocation,and through closed reduction,it recovered well after surgery.One and a half years after Harris hip score,clinical fixation group was 91.69 ? 2.81,joint replacement group was 92.08 ? 2.43,there was no evident difference between the two groups(P > 0.05).Conclusion: PFNA internal fixation and joint replacement are effective treatment for Elderly Unstable Intertrochanteric Fractures.For the PFNA internal fixation,the operation conform to the modern idea of minimally invasive surgery because of simple operation,short operation time,less blood loss,and have the characteristic of proximal femur biomechanics,Suitable for the severe osteoporosis,and preoperative complications,surgical tolerance is poor,unfavorable in patients undergoing a long operation time;Joint replacement have the advantages of early functional exercise,fewer complications,but big trauma than PFNA internal fixation.More suitable for the severe osteoporosis,the medial support damage is serious,not suitable for the patients with fixed way and a shorter life expectancy.When making operation scheme,performer should take more attention to the operation habit and his patients,and formulate specific treatment for the patients. |
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