The Comparison Of Dynamic Hip Screw(DHS),proximal Femoral Nail Antirotation(PFNA)and Intertrochanteric Antegrade Nail(InterTAN)in Treatment Of The Old Osteoporotic Intertrochanteric Fractures

BackgroundIntertrochanteric femur fractures,is also defined as Intertrochanteric fractures,which exactly located at the femoral neck at the base of the capsular line attached to hip joint that above the level of the trochanter.Along with the development of society,constantly progressiveness of the medicine and the continous improvement of quality of life,extension of life expectancy among people.As a populous country,the ratio of aging population exceeding seriously in China,which already become the most proportion of the elderly population around the world,the incidence rate among the old also increase substantially.Because of the degeneration of physical function,the possibility of falling increase dramatically.They are more susceptible to osteoporosis,as the cancellous bone are the main components of intertrochanteric femur,mild violence can lead to fractures.Surgical and conservative treatments consists of the main ways of treating Intertrochanteric fractures,the superiority of conservative treatment contains no secondary traumatization linked to surgery,low risks of infection,lower cost etc.But needed at least 3-months lay up time which more susceptible to complication like thrombosis,pneumonia,pressure sore,etc.This treatment is rarely seen clinically now.With the amelioration of the internal fixation materials and surgical methods,the operative indications are expanding gradually,so the experts advocate that we should proceed surgery earlier when ruled out contradiction of surgeries,which can decrease the complications of long-term bedridden.Meanwhile,early staged functional exercises also can improve quality of life.Internal fixation materials mainly contains central fixation and eccentric fixation,the core materials of former one is PFNA,InterTAN;the principle of the latter one is DHS,therefore,compare the clinical efficacy of three internal fixation methods in Intertrochanteric fractures have vital clinical significance.PurposeTo expore the clinical effects of three kinds of internal fixation methods including dynamic hip screw(DHS),proximal femoral nail(PFNA)and new InterTan nail in the treatment of intertrochanteric fractures in the elderly,and to guide the selection of implants for elder intertrochanteric fractures in clinical practice.MethodsChoosing The fourth affiliated Hospital of Kunming Medical University,from January 2013 to December 2017,a total of 345 elderly patients with intertrochanteric fractures were retrospectively analyzed,contains 99 patients with dynamic hip screw(DHS),138 patients with proximal femoral anti-rotation nail(PFNA),and 108 patients with new proximal femoral nail(InterTan).Through patients medical files,outpatient review and telephone follow ups were recorded.The operative time,intraoperative blood loss,incision length,weight-bearing time,fracture healing time,hip function score(Harris score),postoperative complications were also recorded.ResultsOperative time,intraoperative blood loss,incision length and operative timing,PFNA group and InterTAN group were better than DHS group,and respectively,PFNA group were better than InterTAN group,the differences were statistically significant(P<0.001),considered the partly weight-bearing time,fracture healing time,PFNA group and InterTAN group were obviously better than DHS group,and respectively,InterTAN group were better than PFNA group,the differences were statistically significant(P<0.001).Harris score after operation,PFNA and InterTAN were both better than DHS,and InterTAN group was much more better than PFNA,the differences was statistically significant(P<0.001).For the Harris score 12 month after operation,PFNA and InterTAN group were obviously better than DHS,but there was no differences by the grading scale.In the incidence rate of internal fixation methods related complications and systemic complications,there was no differences between InterTAN and PFNA(p>0.05),but both of them were better than DHS(P<0.05).Conclusions1?Operative time,intraoperative blood loss,incision length and operative timing,Central fixation system(PFNA,InterTAN)were better than eccentricity system(DHS),so compared to the latter one,central fixation can provide better early recovery;2?hip joint functional grading,central fixation have better recvery than eccentricity fixation,but 12 months after operation was no differences by the grading scale.3?PFNA especially suitable for those who have much underlying disease and meanwhile can not suffer long-term Intertrochanteric fractures operation;And Inter TAN more suitable for those patients who can suffer the relatively long-term Intertrochanteric fractures operation.