Comparison Of Two Kinds Of Surgical Treatment For Aged Cerebral Infarction Hemiplegia With Femoral Intertrochanteric Fracture

Objective: Our society has entered the aging stage.Aged osteoporosis has become a common phenomenon.In aged patients hemiplegia with cerebral infarction,the daily activity is significantly reduced,so that osteoporosis is more serious.In such patients,disadvantageous movement of hemiplegic side limb is easier to fall,severe osteoporosis is more likely to occur comminuted intertrochanteric fractures(mostly Tronzo-Evans? and above).The aim of this study is to compare the clinical efficacy of proximal femoral locking plate and cemented femoral head replacement in the treatment of aged cerebral infarction hemiplegia with femoral intertrochanteric fracture.Methods: A retrospective study was conducted to analyze the clinical date of the aged patients who had received surgery in our hospital from June 2014 to December 2016 for femoral intertrochanteric fracture combined with hemiplegia due to cerebral infarction.There were 21 males and 37 females.The age was 60-93 years old with an average age of 78 years.The classification of fractures was Tronzo-Evans: 25 cases of ? type,18 cases of ? type,15 cases of ? type.All the patients were injured at the time of walking,and the injury to the operation time was 2-5 days.According to the different treatment,they were divided into two groups: plate group(proximal femoral locking plate,30 cases)and replacement group(cemented femoral head replacement,28 cases).The 2 groups were compared in terms of incision length,intraoperative blood loss,operation time,intraoperative fluoroscopy times,ambulation time,postoperative complications and Harris score at 6 months postoperation.Results: In the proximal femoral locking plate and cemented femoral head replacement groups,the incision length was respectively(13.0±2.5)cm and(18.1±3.2)cm,the difference was statistically significant(t=6.77;P<0.001),and the incision length in the plate group was smaller;intraoperative blood loss respectively(286.7±194.7)m L and(401.8±175.1)m L,The difference was statistically significant(t=2.36;P<0.050),and there was less bleeding in the plate group;operation time respectively(89.8±14.8)min and(75.2±7.9)min,The difference was statistically significant(t=4.65;P<0.001),and the operation time of the replacement group was less;intraoperative fluoroscopy times respectively(8.4±1.4)time and(1.5±0.5)time,The difference was statistically significant(t=24.45;P<0.001),and the number of fluoroscopy in the replacement group was less;ambulation time respectively(21.3±14.5)d and(8.9±6.4)d,The difference was statistically significant(t=4.18;P<0.001),and the replacement group could move to the ground earlier;postoperative complication rate respectively 56.7%(17/30)and 28.6%(8/28),The difference was statistically significant(?2=4.66;P<0.050),and the postoperative complications were less in the replacement group;the Harris score at 6 month postoperation respectively(57.4±4.6)point and(61.3±5.4)point,The difference was statistically significant(t=7.39;P<0.050),and the Harris score of the hip joint was higher in the replacement group.Conclusion: Since Cemented femoral head replacement has advantages of shorter operative time,fewer intraoperative fluoroscopy times,less ambulation time,fewer postoperative complications and a higher Harris score,It is a good choice of treatment for aged cerebral infarction hemiplegia with femoral intertrochanteric fracture.