| Objective:By comparing the clinical effect of the treatment of intertrochanteric fracture with PFNA and PFLCP,the better internal fixation method for the treatment of intertrochanteric fracture in the elderly was discussed.To provide the basis for the choice of clinical treatment.Methods:This study was a retrospective study.We selected 109 patients with intertrochanteric fractures treated with PFNA or PFLCP in Trauma orthopedics of Shandong Provincial Hospital.Patients younger than 60 years old or died within 12 months after discharge or loss of follow-up were excluded.Finally,83 patients were selected.The patients were aged from 60 to 93 years old(mean 75.4 years old).There were 34 males and 49 females.The patients were divided into PFNA group and PFLCP group.The PFNA group were treated with PFNA and the PFLCP group were treated with PFLCP.Statistical analysis showed that the difference in sex,age,cause of injury and AO classification between the two groups is not statistically significant(P>0.05).The length of hospital stay,operation time,intraoperative bleeding,standing time of complete weight-bearing after operation,fracture healing time,Harris score and excellent and good rate of hip joint function after operation,occurrence and incidence of postoperative complications were observed and compared.Results:83 patients were followed up between 12 months and 24 months(mean 16.3±2.1 months).In the PFNA group,the operation time was between 60 and 120 min(mean 79.10±14.28min),the length in hospital was between 4.17 days and 41 days(mean 14.54±6.90 days),the standing time of complete weight-bearing after operation was between 15 and 45 days(mean 24.95±5.93 days),the healing time of the fracture was between 77 and 100 days(mean 89.67±4.37 days),the intraoperative blood loss were between 50 and 600 ml(mean 179.49± 135.10 ml),and the Harris score of the hip function were between 75 and 94(mean 88.36±5.4)in 12 months after operation.In the statistics of excellent and good rate,25 cases were excellent,10 cases were good,4 cases were medium,0 cases were poor,the excellent and good rate was 89.7%.Postoperative complications:No complications such as cutting of femoral head,loosening or breaking of internal fixation occurred in all patients,and clinical fracture healing was obtained in all patients.Pneumonia occurred in 1 case but it was improved after antibiotic treatment.The venous thrombosis of the lower limbs occurred in 2 cases but were both improved after anticoagulation and thrombolytic therapy.The total complication rate was 7.7%.In the PFLCP group,the operation time was between 85 and 160 min(mean 112.95±17.56min),the length in hospital was between 6.55 days and 34.31 days(mean 14.43 ±6.47 days),the standing time of complete weight-bearing after operation was between 45 and 75 days(mean 54.89±7.16 days),the healing time of the fracture was between 80 and 105 days(mean 91.36 ±5.21 days),the intraoperative blood loss were between 100 and 600 ml(mean 311.36±145.10 ml),and the Harris score of the hip function were between 73 and 94(mean86.5±6.73)in 12 months after the operation.In the statistics of excellent and good rate,24 cases were excellent,12 cases were good,8 cases were medium,0 cases were poor,the excellent and good rate was 81.8%.Postoperative complications:Screw loosened in 1 case.Replacement of the hip was carried out.Steel plate rupture occurred in 1 case and internal fixation removal was carried out.The rest of the patients achieved clinical healing.Urinary tract infection occurred in 1 case and pneumonia occurred in another case but they were improved after antibiotic treatment.The venous thrombosis of the lower limbs occurred in 2 cases but were both improved after anticoagulation and thrombolytic therapy.The total complication rate was 13.6%.The time of fracture healing in the PFNA group were lower than those in the PFLCP group,but there was no statistically significant difference(P>0.05).The days of hospitalization in the PFNA group were longer than those in the PFLCP group,but there was no statistically significant difference(P>0.05).The time of operation and the amount of bleeding during operation and the standing time of complete weight-bearing after operation were significantly lower in the PFNA group than in the PFLCP group,and there was statistically significant difference(P<0.05).The Harris score and excellent and good rate of hip joint function in the PFNA group were higher than those in the PFLCP group at 12 months after operation,but there was no statistically significant difference between the two groups(P>0.05).The incidence of postoperative complications in the PFNA group was significantly lower than that in the PFLCP group(P<0.05).Conclusion:PFNA and PFLCP have similar therapeutic effects on the clinical healing and limb function recovery of intertrochanteric fracture of femur in the elderly,and both of them can obtain satisfactory clinical effects.However,PFNA has obvious advantages in the aspects of operation time,intraoperative blood loss,postoperative complications and early postoperative movement,which can be used as a priority choice for the treatment of intertrochanteric fracture in the elderly. |
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