A Case Study Of 420 Patients With Intertrochanteric Fractures

Objective:To investigate the characteristics,efficacy,prognosis,quality of life,and selfcare ability of patients with femoral intertrochanteric fractures using artificial replacement of femoral head and internal fixation surgery,and provide evidences for clinicians.Methods:In this case study,a total of 420 patients with intertrochanteric fractures were enrolled in Orthopaedic Clinic and Hospital in Qiqihar Central Hospital from January 2014 to December 2016.According to the operation methods of those who met the criteria,166 patients underwent manual replacement of femoral head surgery,and 254 patients with intertrochanteric fractures underwent internal fixation.Collect clinical data including name,age,sex,occupation,marital status,economic status,general information,length of stay,hospitalization costs,imaging data,blood loss during surgery,actual days of hospitalization,medical expenses,and time of getting out of bed.In one,six,and twelve months follow-up,X-rays were reviewed to determine the fracture healing,and the presence of complications(including pulmonary infections,pressure sores,lameness,pain,and venous thrombosis of the lower extremities)was observed.Harris score and self-care ability of ADL patients were recorded.Postoperative functional exercise of hip joints was assessed.The clinical effects and quality of life of different operation methods were collected.Results:1.The 420 cases of femoral intertrochanteric fractures were mainly male patients,the ratio of male to female is 1.6:1.The average age is 61.35 years old.The majority of ethnic groups are Han(98.6%).62.4% subjects’ occupation are production and transportation equipment operators,Most of patients drank liquor(92.9%).2.Gender,age,education level,and BMI of patients with two different operation methods were statistically significant(P<0.05).The proportion of males in the internal fixation group was higher than the femoral head replacement group,patients in internal fixation group were younger than the femoral head replacement group.The internal fixation group has higher education than the femoral head replacement group,but BMI is lower than the femoral head replacement group.There was no significant difference in the national,marital status,occupation,family average monthly income,diastolic blood pressure,systolic blood pressure and alcohol consumption between two groups(P>0.05).3.The average incision lengths of the patients in internal fixation group and the femoral head replacement group were 4.38 cm and 14.39 cm,and the average blood loss during operation was 165.62 ml and 436.65 ml respectively.The mean operation time was 51.36 min and 97.49 min.The average length of stay was 6.34 d and 12.37 d,respectively,the average cost of hospitalization was 18032.12 yuan and 22358.74 yuan respectively,and the mean time to the hospital was 3.45 d and 23.54 d,respectively.4.Leukocyte counts of post-operation was statistically higher than pre-operation in both groups(P < 0.001).The level of white blood cells in patients after surgery was higher than before surgery.The bone mineral density in internal fixation group was lower than pre-operation(P=0.010),while no significant difference were found in femoral head replacement group(P ?0.05).5.The incidence of complications in internal fixation group and femoral head replacement group were 43.70% and 6.02%,respectively.A small propotion of patients had wound infections,which accounted for 3.9% in internal fixation group and 4.8% in femoral head replacement group.The incidence of pulmonary infection in internal fixation group and femoral head replacement group were 13.0% and 0.6%,respectively.The incidence of pain in internal fixation group and femoral head replacement group was 13.4% and 1.2%,respectively.The incidence of venous thrombosis of the lower extremities in the internal fixation group and the femoral head replacement group was 3.9% and 0.6%,respectively.6.The post-operative Hip Harris score increased with follow-up length.At 12 months after surgery,Harris scores were 91.91±0.58,93.09±0.27,and Barthel index scores were 71.76 ±0.54 and 71.70±0.66 in internal fixation group and femoral head replacement group,respectively.7.The correct rate of postoperative rehabilitation training was 93.3% in internal fixation group,100% in femoral head replacement group.The mortality rate of two groups after operation are both 1.2%.Conclusions:1.The majority of patients undergoing intertrochanteric fractures are males.Occupational is mainly for production and transport equipment operators.Most of patients drink liquor.2.Male patients and patients of high education level are more likely to choose internal fixation operation.However,the age and BMI were lower than femoral head replacement group.3.Internal fixation has a smaller length of incision,less intraoperative blood loss,shorter operative time,shorter hospital stay,and less hospitalization costs than femoral head replacement operation.4.The incidence of complications in patients undergoing internal fixation was 43.70%,pain,pulmonary infection,and decubitus were main complications.The incidence of complications in patients undergoing femoral head replacement was 6.02%,incision infection,short-limb deformity of the lower extremities,and pain were main complications.5.Twelve months after surgery,the Harris scores of patients undergoing internal fixation and femoral head replacement operation were 91.91 and 93.09,and the Barthel index scores were 71.76 and 71.70,respectively.