Clinical Efficacy Of Cemented Hemiarthroplasty Versus Proximal Femoral Nail Anti-rotation In Treatment Of Intertrochanteric Fracture In The Elderly Patients Combined With Hemiplegia Due To Cerebral Infarction

Objective:Regarding the choice of treatment methods for intertrochanteric fractures in the elderly,most orthopedics recommend intramedullary fixation now,but the intertrochanteric fractures combined with hemiplegia due to cerebral infarction are of a special type,which tend to be older and have more underlying medical diseases,Osteoporosis is more serious.There are still many disputes about its surgical treatment plan.Therefore,we retrospectively analyzed the clinical efficacy of cemented hemiarthroplasty and proximal femoral nail anti-rotation placement in the treatment of intertrochanteric fracture in the elderly patients combined with hemiplegia due to cerebral infarction.Methods:The clinical data of 61 cases of intertrochanteric femoral fractures combined with hemiplegia due to cerebral infarction between October 2010 and January 2017 were retrospectively analyzed.The subjects were divided into two groups according to different treatment methods.The hemiarthroplasty group included 10 male patients and 19 female patients.The age ranged from 70 to 99 years with an average of 79.5 years.There were 16 cases in the left hip and 13 cases in the right hip.At the same time,this group included 13 patients of modified Evans type III,10 patients of modified Evans type IV and 6 patients of modified Evans type V.The proximal femoral nail anti-rotation group included 12 male patients and 20 female patients.The age ranged from 71 to 94 years with an average of 78.3 years.There were 18 cases in the left hip and 14 cases in the right hip.At the same time,this group included 15 patients of modified Evans type III,12 patients of modified Evans type IV and 5 patients of modified Evans type V.The operation time,intraoperative blood loss,hemoglobin difference before and after operation,postoperative bed time,incidence of perioperative complications,and hip Harris score at 6 months and 1 year after operation were recorded and compared.Results:The average operation time of the hemiarthroplasty group and the PFNA group was 76.2±7.3 and 56.8±5.9 minutes,the average intraoperative blood loss was 240.3±100.0 and 126.5± 55.3 ml,and the total score of hip Harris at 6 months after operation was 55.8±8.1 and 46.2±7.1 points.The difference was statistically significant(P<0.05).The hemoglobin difference before and after operation was 20.7±7.5 and 20.2±6.8 g/L,the postoperative bed time was 3.7±1.2 and 3.1±1.4 days,the incidence of perioperative complications was 21% and 22%,and the total score of hip Harris at 1 year after operation was 63.5 ±7.5 and 61.3±6.5 points.The difference was not statistically significant(P>0.05).Conclusion:Compared with PFNA,cemented hemiarthroplasty for the treatment of intertrochanteric fracture in the elderly patients combined with hemiplegia due to cerebral infarction has better hip function recovery in a short period of time,but the operation time is longer and the intraoperative blood loss is more,and the two operation methods are There were no significant differences in hemoglobin difference before and after operation,postoperative bed time,incidence of perioperative complications,and long-term hip function recovery.