The Comparison And Analysis Of Treating Evans 4 Subtype Intertrochanteric Fracture By Proximal Femoral Nail Antirotation(PFNA ) And Proximal Femoral Locking Plate Combined With Reconstruction Plate

Objectives To compare the clinical efficacy of proximal femoral nail antirotation(PFNA)versus proximal femoral locking plate combined with reconstruction plate in the treatment of EVANS 4 subtype femoral intertrochanteric fracture.Methods From June 2011 to June 2016,153 patients of femoral intertrochanteric fracture(EVANS 4 subtype)were treated surgically at our department.Proximal femoral nail antirotation(PFNA)was adopted in 86 cases,including 31 males and 55 females(mean age,66.4±5.6 years).46 cases of low energy injury,21 cases of high energy injury,48 cases with less than 2 kinds(include 2 kinds)of medical disease,19 cases with more than 2 kinds of medical disease.The 2 groups were compared in time from injury to surgery,terms of operation time,total incision length,intraoperative bleeding volume,postoperative drainaging volume,blood transfusion rate,length of stay,postoperative Garden index,malreduction Immediately after surgery and loss of the reduction 3 months postoperation,full loading time,VAS score and Harris score.Results 153 patients were followed up for 12 to 24 months(average,months).No such complications as incision infection,nonunion,internal fixation failure occurred in this group.Deep venous thrombosis occurred in 16 patients postoperation,All the thrombus disappeared or became stable thrombus after anticoagulant therapy,and the functional exercise postoperation was not affected.There were significant differences in terms of operation time,total incision length,intraoperative bleeding volume,postoperative drainaging volume,blood transfusion rate,length of stay,Garden index,malreduction Immediately after surgery and loss of the reduction 3 months postoperation(P<0.05),but no significant difference in time from injury to surgery,full loading time,VAS score and Harris score(P>0.05).Conclusions Proximal femoral nail antirotation(PFNA)and proximal femoral locking plate combined with reconstruction plate are both effective in the treatment of EVANS 4 subtype femoral intertrochanteric fracture.But in terms of surgical injury,PFNA group is superior to the plate group,and in the perioperative and postoperative situation,long-termfracture,the plate group is superior to PFNA group.There was no statistically significant difference between the two group in terms of total load time,VAS score and Harris score.