Retrosprctive Analysis Of The Curative Effect Of Different Surgical Methods On Intertrochanteric Fracture Of Femur In Elderly Patients

Objective:To compare the clinical effects of the three most commonly used operation methods:femoral head replacement(HHA),Proximal femoral nail antirotation(PFNA)and dynamic hip Screw(DHS)for treatment of intertrochanteric fractures of the femur,for the clinical treatment of intertrochanteric fractures provide basis for reasonable selection of different surgical methods.Method:Selected 63 cases of intertrochanteric fracture patients aged above 75 in our hospital from January 2015 to December 2016,according to different surgical methods for HHA group in 20 cases,PFNA group in 25 cases and DHS group in 28 cases.The operative time,intraoperative blood loss,postoperative partial weight-bearing time,hospital stays,Barthel score of before and after surgery and improvement,healing time after fracture,postoperative complications and Harris scores of 6 months after surgery were recorded and compared in the three surgical methods.Statistical analysis was carried out after data collection of each group and the results were compared with each other.Results:All 63 patients were follow-uped for 6-26 months,average 15.29 ± 1.52 months.Three groups of different surgical methods,PFNA group in operation time and intraoperative blood loss relative to DHS group and HHA group has significant difference,the intraoperative time and bleeding volume is the least(P<0.05).The postoperative partial weight-bearing time and hospital stays of HHA group was significantly different from that of the DHS group and the PFNA group,and the time of the HHA group was the shortest(P<0.05).Barthel scores of before and after surgery and improvement in HHA group were significantly higher than those in DHS and PFNA groups,and statistically were significant differences(P<0.05).The fracture healing time of DHS group was no significant difference with PFNA group(P>0.05).The Harris score of at 6 months after operation showed,HHA group compared with DHS group and PFNA group were significant difference,and the HHA group were significantly higher than that of the other two groups(P<0.05).Conclusion:Three operative methods have advantages and disadvantages in the treatment of intertrochanteric fractures in the elderly.For patients with stable fracture and good general condition,DHS or PFNA can be selected.For patients with unstable fractures and serious medical diseases,HHA can be used to walk down the ground early,reduce postoperative complications and improve the quality of life compared with internal fixation.