Comparative Analysis Of The Efficacy Of Intramedullary Fixation And Extramedullary Fixation In The Treatment Of Subtrochanteric Fracture Of Femur

Objective: The clinical effects of intramedullary fixation and extramedullary fixation in the treatment of subtrochanteric fracture of femur were compared retrospectively,and the advantages and disadvantages of intramedullary fixation and extramedullary fixation in different stages of treatment were discussed.It provides reference for the diagnosis and treatment of subtrochanteric fracture.Methods:From 2013 to 2018,43 cases of subtrochanteric fracture were treated in our hospital(the first affiliated Hospital of Xinjiang Medical University).43 patients with subtrochanteric fracture were treated with internal fixation,of which 27 cases were treated with intramedullary fixation and 16 cases were treated with extramedullary fixation.The patients were followed up for 6 months for 12 months.The basic information,fracture classification and clinical data of the two groups were recorded.The intraoperative and peri-operative conditions were compared between the two types of operation.All patients were followed up for 1.5 months,3 months,6 months and 12 months after operation.Fracture healing was evaluated according to imaging data and hip Harris score was used to evaluate the recovery of hip function.Based on the above data,the curative effects of intramedullary fixation and extramedullary fixation were analyzed in detail.Results: Forty-three patients were followed up and divided into two groups:intramedullary fixation group(group A)and extramedullary fixation group(group B),A group,27 cases,male 21,female 6,mean age 50 years(23 ~89 years);There were 16 patients in group B male 10,female 6,mean age 56.1 years(16~86 years).There was no statistical difference between the two groups(P > 0.05).The operative time,intraoperative bleeding and total load-bearing time in group A were significantly shorter than those ingroup B(P < 0.05).There was no significant difference in Harris score and fracture healing time between the two groups 3 months after operation.Follow-up for 12 months showed bone nonunion in group A(n = 1).Harris score: excellent in 16 cases,good in 8 cases,medium in 2 cases and poor in 1 case.The excellent and good rate was 89%.Group B(n =1)had nonunion of rough bone and fracture of internal fixation.The Harris scores were excellent in 7 cases,good in 6 cases,medium in 2 cases and poor in 1 case.The excellent and good rate was 81%.According to Seinsheimer classification,there were 2 case of type?,5 cases of type ?,10 cases of type ?,12 cases of type ? and 14 cases of type V.Conclusion: Both intramedullary fixation and extramedullary fixation can achieve good results in the treatment of subtrochanteric fractures.Intramedullary fixation has some advantages in operative time,intraoperative blood loss and early load-bearing.It can not be concluded that intramedullary fixation is superior to extramedullary fixation..Limited open reduction is a reliable surgical technique.The treatment of fracture reduction according to the type of fracture and the skill of operation are of great significance to the operative effect and prognosis of the fracture.