| Objective: To observe the effect of artificial femoral head replacement and proximal femoral nail anti rotation(Proximal Femoral Nail Antirotation,PFNA)internal fixation in the treatment of elderly femoral intertrochanteric fracture curative effect,summarize two compared advantages and disadvantages,and provide a theoretical basis for the treatment of senile intertrochanteric fracture.Methods: referring to the relevant standards of clinical research design,measurement and evaluation,follow the design review,comparative study,70 cases of old aged from January 2015 to January 2017 during the period of treatment in Department of orthopedics of Affiliated Hospital of Luzhou Medical College,PFNA treatment,femoral head replacement or complete medical records(over 80 years)of intertrochanteric fracture patients as the research object.Based on the operation mode,the artificial femoral head replacement and PFNA internal fixation were treated as observation group(33 cases)and control group(37 cases).The baseline data through the Excel collection form into the group's(sex,cause of injury,fracture side,Evans type,basic disease,age,body mass index),perioperative indicators(injury to operation time,incision length,intraoperative bleeding volume,operation time,postoperative ambulation time,the postoperative hospital stay),hip joint function and curative effect after third,sixth,twelfth months(Harris score),complications,health economics indexes(medical costs,cost-effectiveness ratio,sensitivity analysis).The statistical analysis was done by SPSS20.0,and the standard of statistical difference was P<0.05.Results: the two groups of gender,cause of injury,fracture side,Evans type,basic disease,age,body mass index and baseline data of well balanced(P>0.05),comparable.The completion of the study for reasons: follow-up and follow-up time less than 12 months,poor compliance,re operation,lost and accidental death were removed in 7 cases(2 cases in the observation group,5 cases in the control group),90%(63/70)patients completed the study,obtained(12-26)months of follow-up,median follow-up between 16 months.The perioperative indicators: injury to the operation time,postoperative hospitalization time,two group(P>0.05);the total length of the incision,the amount of bleeding during the operation,the observation group respectively(15.13±2.14),cm(300.36±56.13)ml,more than the control group(7.56±1.54)cm,(150.23.31.24)ml(P<0.05);the operation time,postoperative ambulation time,observation group respectively(55.23±5.69),min(4.56±1.35)days,less than the control group(70.23±6.32),min(15.24±3.06)days(P<0.05).The total score of Harris of the patients in the observation group after 3 months was higher than the control group(P<0.05);close to 6,12 months after operation in the two groups(P>0.05).The effect of the observation group after 3 months,the excellent rate of 93.55%,higher than 71.875% in the control group(P<0.05);the observation group after 6 and 12 months,the excellent rate was 96.77% and 96.77%,with no significant differences between the control group and the difference of 87.50% 90.625%(P>0.05).No complications: the observation group of 1 cases of fat liquefaction of incision,1 cases of recurrent hip pain;the control group of 1 cases of delayed healing,1 cases of fat liquefaction,1 cases of femoral head cutting,2 cases of pneumonia,1 cases of pressure ulcer,1 cases of deep venous thrombosis.The incidence of complications in the observation group was 6.45%,lower than that of the control group(21.875%(P<0.05)).One index of Health Economics: in the observation group,the medical cost accounted for 50.33%,accounted for 6.27% of non medical costs,indirect costs accounted for 33.40%;in the control group,the medical cost accounted for 33.45%,accounted for 8.06% of non medical costs,indirect costs accounted for 58.49%;two groups of medical costs constitute a statistically significant difference(P<0.05)distribution ratio.The cost of materials,the total cost of the observation group than the control group(P<0.05);drug fees,inspection fees,treatment fees and other expenses,lost income,two group(P>0.05);observation group about the cost-effectiveness of 8718.17 yuan,5858.36 yuan higher than the control group;sensitivity analysis,the material costs,loss of working time fee plus or minus 10%,the observation group cost effectiveness ratio is still higher than the control group.Conclusion: artificial femoral head replacement and PFNA internal fixation are effective treatments for elderly patients with intertrochanteric fractures.Hemiarthroplasty has the advantages of early ambulation and fewer complications.PFNA has less incision,less bleeding and lower cost to effect ratio. |
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