| Objective: To compare the results between proximal femoral nail anti-rotation(PFNA)and dynamic hip screw(DHS)for the unstable pertrochanteric fractures with lateral wall riskyMethods: Retrospectively analyzed from September 2009 to March 2012 DHS and September 2014 to March 2016 PFNA treatment and have complete data of 120 cases of the unstable pertrochanteric fractures with lateral wall risky in patients(AO31-a2.2 and AO31-a2.3).With PFNA internal fixation group of 61 cases,including 26 males and 35 females,aged 63-89,with an average age of 72.3 ± 10.7 years,height is 1.54-1.76 m,with an average of 1.63±0.07 m,and the weight is 42-69 kg,with an average of 54.64± 11.96 kg.Causes to hurt 54 cases,car accident 7 cases.The AO classification of fracture AO 31-A2.2 type 34,AO31-A2.3 27 cases.DHS internal fixation group of 59 cases,23 cases of men,and 36 cases of women,aged 64-87,mean age 73.2 ± 8.8 years old,height is 1.53-1.75 m,with an average of 1.62 ± 0.08 m and a weight of 43-68 kg,with an average of 53.90±10.28 kg.Causes to fall 55 cases,car accident 3 cases,a fall 1 case.The AO classification of fracture AO 31-A2.2 type 33,AO31-A2.3 26 cases.Comparison of two groups of patients with the main incision length,operation time,blood loss.The part load time,total load time and fracture clinical healing time were observed and compared between the two groups.To observe the complications of the hip and the functional status of the joints over 9 months after surgery.Results: All patients after 9 ~ 18 months(mean follow-up of 11 months).PFNA group and DHS group two groups of surgical incision length,operative time,intraoperative bleeding and postoperative lead flow conditions,including PFNA operation main incision length[(4.8±0.9)cm],operation time [(38.3±12.7)min],intraoperative blood loss[(128± 52)ml] and postoperative led traffic for [(40.2 + 9.6)ml] were better than DHS group [(9.2 ±1.2)cm,(65.2±11.8)min,(280 ± 194)ml and(130 ± 20.7)ml],statistically significant difference(p < 0.05).However,the total blood loss in the PFNA group was [(753 ± 277.8)ml],and the difference in the DHS group [(766 ± 252.4)ml)was not statistically significant(p > 0.05).The latent blood loss of PFNA [(592 + 264.7)ml],the difference of the DHS group [(421 ± 226.3)] was statistically significant(p < 0.05).In the PFNA group and the DHS group,the part load time,total load time,fracture clinical healing time were compared,and the part load time of the PFNA group was [(7.2 ± 1.8)days].Total load time [(12.1± 2.2)weeks];The duration of fracture healing [(14.9±3.2)weeks] was superior to the patients in the DHS group [(25.5 ± 4.6)days,(15.3 ± 3.9)weeks;(16.3 ±5.2)weeks],and the difference was statistically significant(p < 0.05).Two groups of hip complications were compared,the femoral shaft splitting in the PFNA group was 1 case,2 cases of lateral wall injury in the hospital,1 case in the hip,1 case of limb shortening and 1 case of pain in the front of the thigh.In addition,there were 5 cases of external lateral wall injury in DHS group,3 cases in the hip,3 cases of limb shortening,1 case of internal fixation,2 cases of malformation,and 1 case of internal fixation fracture.The total complications of PFNA and DHS were respectively 7 and 15,the difference was statistically significant(p < 0.05).The optimal rate of hip function was reviewed at the end: the PFNA group(91.8%)was superior to the DHS group(83.0%),and the difference was statistically significant(p < 0.05).Conclusions: Compared with DHS,the treatment of unstable pertrochanteric fractures with lateral wall risky in PFNA can reduce the incision length,operation time,intraoperative bleeding and postoperative discharge,and have fewer surgical complications,early postoperative load,quick recovery of fracture,and good recovery of hip function,which is worth clinical promotion.However,there was more recessive bleeding after PFNA,and the total loss of blood loss during perioperative period did not decrease,which required the attention of clinicians. |
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