Comparing Clinical Outcomes Of Proximal Femoral Nail Antirotation With Hemiarthroplasty In Teratment Of Elderly Patients With Unstable Intertrochanteric Fracture

Objective:By comparing the clinical outcomes of proximal femoral nail antirotational(PFNA)and hemiarthroplasty(HA)in treatment of elderly patients with unstable intertrochanteric fractures,the indications,advantages and disadvantages of the two surgical methods are discussed to provide guidance for more effective treatment results.Methods:We retrospectively analyzed the clinical outcomes of 86 elderly patients with unstable intertrochanteric fractures who underwent surgical treatment at the Orthopaedics Department of Lu'an People's Hospital from June 2015 to June 2018.All patients were divided into PFNA fixation group or HA group according to the surgical method,forty six patients in the PFNA fixation group and forty patients in HA group,they were followed-up for 12 months.The operation time,intraoperative blood loss and postoperative weight-bearing time the Visual Analogue Score,Activity of Daily Living(Barthel index),Hip Harris score at 1,3,6,and 12 months after surgery and excellent rate of hip function at last follow-up,postperative complication rate were compared between the two groups.Results:In the PFNA fixation group,the operation time and intraoperative blood loss were significantly less than the HA group,but the postoperative weight bearing time was significantly later than the HA group,the difference was statistically significant(P<0.05).The VAS score of patients in the PFNA fixation group was statistically significant higher than that in the HA group at 1 and 3 months after surgery(P<0.05),but there was no significant difference at 6 months and longer time after operation.The activity of daily living(Barthel index)and hip Harris score in the PFNA fixation group were worse than those in the HA group at 1,3,and 6 months after operation.the difference was statistically significant(P<0.05),but the two groups were similar at 12 months of follow-up.The excellent and good rate of hip function at the last follow-up:PFNA fixation group(89.13%)versus HA group(87.50%),no statistical difference between the two groups(P=0.814).The complication rate was 10.87%in the PFNA fixation group,including 2 cases of cut-out,1 case of deep vein thrombosis,1 case of pulmonary infection,and 1 case of sacral tail pressure ulcer,While 5.00%in the HA group,respectively was 1 case of superficial infection at the surgical site and 1 case of pulmonary infection.There was not observed dislocation of prosthesis or periprosthetic fracture,The PFNA fixation group may have more complications than HA group,but no statistical difference(P=0.986)Conclusion:For the surgical treatment of elderly unstable intertrochanteric fractures,PFNA fixation has shorter operation time,less intraoperative bleeding,and less trauma to elderly patients.However,patients treated with HA can achieve earlier weight-bearing activities,the pain is milder,higher quality of life,and the outcomes is better in the short term,but it significantly increases surgical trauma and bleeding,als the long-term efecacy of HA is not better than PFNA.Therefore,PFNA internal fixation is preferred for the treatment of elderly patients with unstable intertrochanteric fractures,HA is suitable for some patients,and its indications should be strictly controlled.