The Comparison Of Dynamic Hip Screw (DHS), Proximal Femoral Nail Antirotation (PFNA) And Intertrochanteric Antegrade Nail(InterTan) In Treatment Of The Old Osteoporotic Intertrochanteic Fractures

BackgroundIntertrochanteric fractures,also known as intertrochanteric fractures,are common low-energy injuries in the elderly.With the aging of society and the prolongation of life expectancy,the incidence of femoral intertrochanteric fractures is on the rise.As the most populous and developing country in the world,China is rapidly entering a long period of aging.It is estimated that around 2025,the number of elderly people aged 60 or above in China will exceed 300 million people;by 2033 or so,the number of elderly people aged 60 or above in China will exceed 400 million people;and by 2053 or so,it will reach the highest value in the 21st century.4.82 billion people.Due to the decline of the visual,auditory,and motor functions of the elderly,the overall reaction capacity of the various systems of the body is reduced,and the probability of occurrence of trauma is also significantly increased.The cancellous bone is dominated by the cancellous bone.Osteoporosis destroys the microstructure of the trabecular bone,causing minor fractures.Before the 1990s,conservative treatment was often used for patients with intertrochanteric fractures in the elderly because of medical restrictions and economic conditions.Conservative treatment has minimal trauma to the patient,low risk in the near future,and low medical costs.However,conservative treatment requires the patient to stay in bed for a long time and is prone to serious complications such as pulmonary infection,urinary tract infection,and acne caused by long-term bed rest.With the improvement of internal fixation materials and surgical methods,the level of perioperative diagnosis and treatment and the safety of surgery have been significantly improved,and the indications for surgical treatment have also been considerably expanded.It is now advocated that patients with conditional intertrochanteric fractures should be treated as soon as possible.Surgical treatment allows patients to get out of bed early,reduce the complications caused by long-term bed rest,improve the quality of life of patients,reduce mortality.Therefore,to explore the clinical efficacy of different internal fixation methods for treatment of intertrochanteric fracture in the elderly has important clinical significance.PurposeTo investigate the clinical effects of three kinds of internal fixation methods including dynamic hip screw(DHS),proximal femoral nail(PFNA)and new InterTan nail in the treatment of intertrochanteric fractures in the elderly.MethodChoosing dynamic hip screw(DHS),proximal femoral anti-rotation nail(PFNA),and new proximal femoral nail(InterTan)in the Orthopaedics Center of Zhujiang Hospital,Southern Medical University from January 2010 to January 2016 A total of 120 elderly patients with intertrochanteric fractures were retrospectively analyzed,including 40 patients in the DHS group,60 patients in the PFNA group,and 20 patients in the InterTan group.Through patient history,outpatient review,and telephone network,follow-ups were performed.The operative time,intraoperative blood loss,incision length,length of hospital stay,weight-bearing time,fracture healing time,hip function score,intraoperative and postoperative complications were recorded.ResultsIn operative time,intraoperative blood loss,ncision length,InterTan group and PFNA group were better than DHS group,the differences were statistically significant(P<0.05),there was no significant difference between group InterTan and group PFNA(P>0.05).In postoperative weight-bearing time,fracture healing time,Harris score one month after operation,InterTan group was better than DHS group and PFNA group,PFNA group was better than DHS group,the differences were statistically significant(P<0.05).In hospitalization time,Harris score six months after operation and Harris score twelve months after operation,there were no significant difference among the three groups(P>0.05).In the incidence rate of intraoperative and postoperative complications,InterTan group and PFNA group less than DHS group,the differences were statistically significant(P<0.05).ConclusionCompared with the DHS system,PFNA and InterTan have the characteristics of less trauma,simple operation,quick postoperative recovery and less complications,and show good clinical efficacy in the treatment of intertrochanteric fractures of the femur.Compared with PFNA system,InterTan system has better fracture fixation and stability,shorter fracture healing time,and better biomechanical advantages.