| With the rapid development of society,people's mean life increases.Intertrochanteric fracture of femur is one of the most common fractures in the elderly,and its incidence is also increasing year by year.Non-surgical treatment is often difficult to satisfy the functional requirements of patients,and is liable to cause many complications,such as coxa vara,extremity rotation,shortening deformity,long-term bed rest is liable to cause pressure sores,pulmonary and urinary tract infections,deep venous thrombosis and other systemic complications,the mortality and disability rate increased significantly.At present,surgical treatment is the main method,and there are many surgical methods.At present,PFNA and InterTan new intramedullary nails are popular,and some scholars use hip replacement to treat such fractures.In view of the special population of the elderly,which surgical method is more conducive to the recovery of the function and general condition of the elderly patients,this study can provide clinical data support.Objective:To compare and analyze the clinical effects of three surgical methods(PFNA?InterTan nail and Hemiarthroplasty)in the treatment of femoral intertrochanteric fracture in elderly patients.Methods:Collect the elderly patients with intertrochanteric fracture admitted to the Affiliated Hospital of Chengde Medical College from April 2014 to April 2017.A retrospective study has been conducted to analyze the Sixty-eight patients who who met the inclusion criteria.Fourteen patients were male,forty-four patients were female,aged from 68 to 94 years,with an average of(79.99±5.64)years.According to the operation mode,the patients were divided into three groups:Thirty-five patients were treated with PFNA considered as group A,thirteen patients were treated with InterTan nail considered as group B,twenty patients were treated with Hemiarthroplasty considered as group C.According to the required research and observation indicators,the data of the three groups before and after operation were sorted out,such as fracture classification,operation time,intraoperative blood loss,postoperative time of getting out of bed,hospitalization days,postoperative complications,postoperative Harris score(1 month,5 months and 9 months).The above observation indicators were analyzed by SPSS19.0 software.Results:All the patients passed the perioperative period smoothly,the incision healed in phase I,and were reviewed regularly after discharge.Two patients lost follow-up after one month(one case in group A and one case in group C).Five patients died 3-4 months after operation(3 cases in group A and 2 cases in group C).The remaining patients were followed up for 9 months to 12 months.The average operation time in group A was(96.03±14.01)minutes,and the average intraoperative bleeding volume was(104.29±17.87)ml.The average hospital stay was(12.97±4.28)days,the Harris score was(61.47±7.02)one month after operation,postoperative time of getting out of bed was(10.49±1.63)days.The average operation time in group B was(92.69±8.81)minutes,and the average intraoperative bleeding volume was(98.46±9.87)ml.The average hospital stay was(10.15±1.35)days,the Harris score was(68.31±2.75)one month after operation,postoperative time of getting out of bed was(9.15±0.90)days.The average operation time in group C was(113.75±12.55)minutes,the average amount of bleeding during operation was(372.50±144.62)ml,the average length of hospitalization was(20.90±2.53)days,the Harris score was(74.26±9.31)one month after operation,and postoperative time of getting out of bed was(7.65±1.57)days.There were significant differences in hospitalization days,activity time and Harris score in one month between the three groups(P < 0.05).The operation time,intraoperative bleeding volume and hospitalization days of group A and B were better than those of group C,and the difference was statistically significant(P < 0.05).The Harris score of group C was better than that of group A and B one month after operation,the difference was statistically significant,but there was no significant difference in Harris score(5 months,9 months)and postoperative complications(3 cases in group A and 2 cases in group B and 2 cases in group C)among the three groups(P > 0.05).Conclusion:Compared with Hemiarthroplasty,PFNA and InterTan nail can achieve good clinical results in the treatment of intertrochanteric fracture in the elderly.However,intramedullary fixation has the advantages of shorter operation time,less blood loss and shorter hospitalization days.Although the time of landing after operation is slightly longer than that of Hemiarthroplasty group,Harris score(1 month after operation)is lower than that of femoral head replacement group,there is no significant difference in Harris score(5 months,9 months after operation)between the three groups in the long term and there was no increase in postoperative complications.Whether PFNA or InterTan,it can basically meet the treatment of elderly trochanteric fracture.The unique design of InterTan nail system makes it more suitable for intertrochanteric fracture,especially for elderly osteoporosis patients and complex intertrochanteric fracture,which is more conducive to fracture stability,bone healing and functional recovery than PFNA. |
PDF Full Text Request