| Purpose:(1)To retrospectively analyze the effects of surgical treatment of femoral trochanteric fractures and to clearify the advantages and disadvantages of intramedullary or extramedullary fixation.(2)To compare clinical results and complications of different length intramedullary nail for treatment of femoral trochanteric fractures by randomized controlled trials.Methods:(1)We retrospectively analyze the records of patients who suffered intertrochanteric fractures and reciecved surgical treatment between January 2011 to October 2014 in the first study.Inclusion and exclusion criteria are as follows: good data record;intertrochanteric fractures confirmed by X-ray and CT without metastatic cancer pathological changes,etc.We collected imformation including age,sex,sides,AO type,bone mineral density,type of fixation,operation time,HGB and HCT 24 hours before and after operation,transfusion and complications.(2)In the second study,patients who participated in this trail were randomized in long nail fixation group or short nail fixation group.They were treated surgically by a same orthopedic surgeons.Basic and surgical informations were recorded from hospitalization to follow-up at least 12 months.Result:(1)168 out of 246 patients met the inclusion criteria including 62 males and 106 females with average age(65±13.4,74±9.4)years.Patients aged from 60 to 90 years old occupied the most population.According to the classification by AO/OTA,54 patients were classified as type A1,100 patients as type A2 and 14 patients as type A3.DYNAMIC HIP SCREW and PERCUTANEOUS COMPRESSION PLATE were the two implants in the extramedullary fixation group,including 22 males and 32 females with average age(71±13.8,72±8.1)years old,all of whom were classified as type A1.The HGB and HCT tested 24 hours before operation were(116.9±9.2,124.2±14.5)g/L and(35±3,36.5±3.7)% without significant difference.After similar operation time(81.1±17.4,86.1±17.6),the HGB and HCT tested 24 hours after surgery were lowered down to(101.6±6.1,114.2±13.7)g/L and(30.1±2.4,33.3±3.7)% with significant performance in PERCUTANEOUS COMPRESSION PLATE.However,the patients who needed blood transfusion and the volume were similar in both groups.PFNA and Gamma 3 nail were the two implants in the intromedullary fixation group,including 50 males and 64 females with average age(65±12.7,75±10)years old.According to the classification by AO/OTA,32 patients were classified as type A1,68 patients as type A2 and 14 patients as type A3..The HGB and HCT tested 24 hours before operation were(116.4±17,120.6±15.4)g/L and(34.3 ± 4.8,35.3 ± 3.9)% without significant difference.After similar operation time(84.5±24.7,78.3±23.1),the HGB and HCT tested 24 hours after surgery were lowered down to(106.4±13.8,108.7±11.6)g/L and(32.1±3.6,31.3±3.1)% without significant difference.Besides,the patients who needed blood transfusion and the volume were similar in both groups.Wound infection was the major problem in extramedullary fixation group.(2)56 patients met the inclusion criteria including 28 patients in both groups.The average age were(65±13.4,74±9.4)years for the long and short nail group.According to the classification by AO/OTA,9 patients were classified as type A1,14 patients as type A2 and 5 patients as type A3 in the long nail group,while 9 patients were classified as type A1,15 patients as type A2 and 4 patients as type A3 in the short nail group.The HGB and HCT tested 24 hours before operation were(125.6±17.0,125.3±16.5)g/L and(34.2±4.7,35.1±4.3)% without significant difference.After operation time(61.5±11.8,45.3±9.2)minites,the HGB and HCT tested 24 hours after surgery were lowered down to(96.5±10.2,102.1±11.8)g/L and(30.1±3.4,32.2±3.8)% with significant better performance in short nail fixation group.However,the patients who needed blood transfusion and the volume were similar in both groups.Similar Harris functional score(84.8±5.6,84.2±5.6)were reached at 12 months' follow-up.Hip varus,nail cut-offt,refracture were noticed in both groups.Conclusion:(1)By strictly choosing the appropriate cases for extramadullary fixation,we can obtain good therapeutic effect in treatment of stable type fractures and avoid related complications,regardless of the DYNAMIC HIP SCREW or PERCUTANEOUS COMPRESSION PLATE after internal fixation.(2)Short intramedullary nailing can shorten operation time and reduce blood loss comparing with long nails.There was not significant differce in terms of surgical complications. |
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