| Objective: To observe the anti-rotation type proximal femoral nail(PFNA), dynamic hip screw(DHS), Gamma nail three kinds of surgical treatments for the clinical efficacy of intertrochanteric fracture.Methods: A retrospective analysis from October 2013 to October 2015 and the first Hospital of Hubei Province, Wuhan orthopedic hospital treated osteoporotic intertrochanteric fractures were 80 cases, 36 male patients, 44 female patients, the oldest 84 and the youngest 61 years old, 38 cases are the left and 43 cases are right side.According to different surgical methods, 80 patients were divided into 3 groups, a group of 29 cases,which are fixed by PFNA, 13 male cases, 16 females, aged from 60 to 85 years, average(72.2 ± 2.3) years; 31 cases of group B use DHS fixation, including 14 males and 17 females, aged from 60 to 82 years, average(71.1 ± 2.4) years; 20 cases of group C,which use the Gamma nail fixation, 9 males and 11 females, aged 61 to 84 years, average(71.5 ± 2.1) years. By the statistical test, three groups were generally the difference was not statistically significant(P> 0.05), it is comparable. Before and after surgery,3 groups of patients are used in traditional Chinese medicine of three internal medicine dialectical therapy. Surgery were combined spinal epidural anesthesia(CSEA) or general anesthesia. 1) anesthesia satisfaction Orthopedics traction bracket closed reduction, PFNA group of patients cut above the apex of greater trochanter with small longitudinal incision, insert the needle at the outside of the big rotor vertexl after reset satisfaction,inserted through the nail after positions satisfaction, guide the needle into the femur internal jugular, perspectives the guide needle position satisfaction, and install anti-rotation and lock blade, then installation distal locking screw and end cap. 2) After anesthesia satisfaction,Orthopedics traction bracket closed reduction(reduction not satisfied can open to reset), DHS group of patients can cut outside of the hip line longitudinal incision to expose the greater trochanter and femur, into the guide wire of compression screw after perspective position satisfaction,then implantation compression screws, and into the side of the steel sheet finally. 3) After anesthesia satisfaction,Orthopedics traction bracket closed reduction, longitudinal incision from the tip of the greater trochanter of the femur, layer by layer separation, guide pin placement at the greater trochanter prior to 1/3 at the junction of medial punch,expand the marrow cavity, internal carotid femoral screw in tensile screws, and then into the distal locking screws, screwed into the end cap after removed the sight.; 4) 3 groups of patients were carried out at C-wall perspective. Rinse the postoperative, place the drainage tube,sewn up step by step, use of antibiotics if necessary. Three groups were compared in operation time and blood loss, treatment effect, joint function changes before and after operation and postoperative complications.Results: The treatment effect is assessed according to Harris hip score determination, excellent: 90 to 100 points; good: 80 to 89 points; general: 70 to 79 points; poor: <70 points. Harris hip score take 100-point scale, pain(44 points), function(47 points), range of motion(5 points) and limb deformities(4 points),four projects were evaluated. Observe patients before surgery and six months ratings situation. Followed up for 6 to 12 months, recording the patient's condition complications. The rates of good treatment of PFNA group and Gamma nail group were higher than the DHS group(P <0.01); After six months, the hip function recovery of PFNA group and the Gamma nail group superior DHS group(P <0.01); Postoperative complications of PFNA group and Gamma nail group are the same(P>0.05), DHS group was the highest(P <0.01). Conclusion: In osteoporotic intertrochanteric fractures, PFNA and Gamma nail rgery can achieve good results, the prognosis was better than DHS, they are the preferred treatment of intertrochanteric fracture surgery methods. |
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