| Objective: To investigate the proximal femoral nailing anti—rotation(PFNA)and total hip arthroplasty(THA)treatment of senile intertrochanteric fractures of the clinical curative effect,the operation time,intraoperative bleeding volume,postoperative complications and joint function recovery,and postoperative Harris score,discuss two surgical treatment of senile femoral intertrochanteric fracture rough indications,surgical techniques and perioperative treatment,analysis of the relationship between the two kinds of operation type and fracture type,provide a reference for senile intertrochanteric fracture selection of operation.Methods: Retrospective analysis from January 2012 ~ January 2016 in Wuhan Wudong hospital hospitalized 78 cases of intertrochanteric fracture were treated with anti rotation proximal femoral nail(PFNA)and 30 cases of total hip arthroplasty(THA)treatment in48 cases,male 46 cases,female 32 cases,age 67-89 years old,the average age of 76.54 years.Evans type,II type(intertrochanteric fractures with displacement,the size of the rotor complete)in 27 cases,type III(with greater trochanter fracture,displacement,lateral support,no complicated posterior comminuted fractures in 20 cases),type IV(with small rotor fracture displacement,no medial support)29 cases,V type(except for intertrochanteric fractures,the size of the rotor are single fracture,lateral and medial support after 2 cases).Preoperative preparation for 5 to 7 days,in the case of severe displacement or insertion of the fracture,the affected side of tibial tubercle traction.Group: A group(PFNA): 30 cases,including 13 cases of male,female 17 cases,aged 67 to 83 years old,the average age of73.46 years(THA);group B: 48 cases,including 19 cases of male,female 29 cases,aged 69 to 89 years old,the average age of 79.62 years.The operation time,intraoperative blood loss,postoperative complications and postoperative recovery of joint function,as well as postoperative Harris score results were analyzed statistically.Results: In this group of 78 patients,the follow-up data were obtained within 6 months after surgery,with a total follow-up rate of,of which there were 26 cases in the A group,the follow-up rate was 86.67%,B group of 41 cases,the follow-up rate was 85.42%.Except A group,l cases of fracture nonunion,no infection occurred in two groups after operation.Operation time,intraoperative blood loss,postoperative Harris score was statistically significant(P<0.05),1 months after surgery,at the end of the 3 months,the Harris score was no significant difference between the 6 months.Conclusion:Through statistical software after statistical analysis,intraoperative bleeding volume,operation time,postoperative complications,and postoperative time all have statistical significance,after 1 month,3 months,6 months Harris scoring results no significant difference.PFNA intraoperative incision length with surgical operation,the advantages of smaller,less intraoperative bleeding amount;Artificial total hip replacement has the advantages of less postoperative complications,and activity time early,in two sets of data after 6 months follow-up Harris score had no significant difference,prove that PFNA and THA type in the treatment of elderly unstable intertrochanteric fractures are effective.For PFNA can completely by minimally invasive small trauma,less bleeding,the patient against the advantages of small,can be used for treatment of such fractures.And very serious when patients with osteoporosis,internal fixation after implant stability is not reliable,can consider to do THA;Or internal fixation failure cases,surgery is difficult to obtain stability,THA can be used as a remedial measures;Fracture with femoral head ischemic necrosis or degenerative osteoarthritis,THA can solve the problem of fracture and the primary disease two at the same time.Actual situation,should be based on patients after evaluate the various aspects of choosing the most suitable operation method. |
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