A Comparative Study On The Treatment Of Unstable Intertrochanteric Fracture Of Femur With Artificial Bipolar Femoral Head Replacement And Gamma3 Nail Fixation

Objective: To discuss the short term clinical effect of artificial bipolar femoral head replacement with biological lengthening handle and gamma3 type intramedullary nail fixation in the treatment of unstable intertrochanteric fracture of femur.Methods: From July 2014 to February 2017,68 patients with unstable femoral intertrochanteric fracture treated by surgical treatment from July 2014 to February 2017 were followed up and divided into two groups according to different surgical methods.Forty patients with biological hemiarthroplasty were divided into group A(arthroplasty group).Twenty-eight patients with gamma3 type intramedullary nail fixation were divided into group B(Gamma3 nail internal fixation group).The patients were followed up for 12 months.The main indexes were operation time,blood loss,the time of getting out of bed after operation,the motion of hip joint at the 12 th month after operation.The excellent and good rate of hip function Harris score and the incidence of postoperative complications were analyzed statistically.Results: The operative time of group a(arthroplasty group)was longer and the amount of operative bleeding was more than that of group B(P < 0.05).The comparison of hip motion,harris score and good rate between group A(arthroplasty group)and group B(Gamma3 nail fixation group)during the last follow-up was better than that in group B(P < 0.05).In the last follow-up group,there were 2 cases of dislocation of hip in group A(arthroplasty group),which were treated with manual reduction under anesthesia.One patient with deep venous thrombosis of lower extremity was treated with anticoagulant and conservative therapy.Group B was cured by internal fixation of gamma3.There were 2 cases of delayed fracture healing,which were treated with symptomatic observation.There were 2 cases of internal fixation failure,femoral neck tension screw cut out the femoral head,the internal fixation was removed by surgery,and joint replacement was performed.There was one case with femoral head necrosis.The incidence of complications in group A(arthroplasty group)and group B(Gamma3 nail fixation group)was better than that in group B(P < 0.05).At the last follow-up,2 patients died in group A(arthroplasty group)and 3 patients lost interviews.No death cases associated with intertrochanteric fracture were found in group B(Gamma3 nail fixation group).2 patients died and 2 patients lost their visit at the last follow-up.However,2 cases of death were not associated with intertrochanteric fracture of femur.Conclusion: 1.For the unstable femoral intertrochanteric fracture,both artificial bipolar femoral head replacement with biological lengthening handle and gamma3 intramedullary nail internal fixation can improve the function of the joint and obtain good clinical results.2.For the biological type of femoral intertrochanteric unstable fracture with The gamma3 type intramedullary nail group had advantages in operation time and blood loss.With artificial bipolar femoral head replacement with biological lengthening handle,the weight bearing function was earlier,the Harris score of arthroplasty was higher,and the postoperative complications were less,which was more superior than gamma3 type intramedullary nail.