| Objective:To explore the efficacy comparison of proximal femoral anti-rotational intramedullary nail(PFNA)in the treatment of intact lateral wall and dangerous lateral femoral intertrochanteric fractures.Methods:A total of 67 patients who were admitted to Subei People's Hospital in Jiangsu Province from June 2016 to January 2019 for intertrochanteric fractures were divided into 37 cases based on Gotfried classification and 37 cases with complete lateral wall.In both cases,both groups were treated with PFNA.The follow-up period ended January 2020.One case(female)was lost in the intact lateral wall group and one case(female)was in the lateral wall dangerous group.Analyze and compare the general data of the two groups of patients(age,gender,body mass index(BMI),fracture side,American Society of Anesthesiologists classification(ASA classification)and time from injury to operation),perioperative data(thickness of the lateral wall,operation Time,hospital stay,intraoperative blood loss,postoperative hidden blood loss,total blood loss,intraoperative and postoperative complication cases),follow-up data after discharge(partial weight-bearing time after operation,complete weight-bearing time after operation,Fracture healing time,Harris hip function score(HHS),Harris hip function score excellent rate,and incidence of complications after discharge).Statistical analysis of the two sets of data to draw conclusions.Results:Among the 65 cases of patients were followed-up for 8?12 months,averaged 11.2 months.There was no statistically significant difference in age,gender,BMI,fracture side,ASA classification,and injury-to-operation time between the outer wall intact group and the outer wall risk group(P>0.05).The intact lateral wall group took(55.69±7.67)minutes,the length of hospital stay(12.17±1.81)days,the intraoperative blood loss(117.6±12.84)ml,and the postoperative hidden blood loss(712.08±79.92)ml,the total bleeding volume.(829.72±82.75)ml,postoperative partial weight-bearing time(7.44±1.25)w,postoperative full weight-bearing time(12.28±1.34)w,fracture healing time(16.50±1.44)w,and operation time of the lateral wall danger group(65.17±11.53)min,hospital stay(13.55±2.06)d,intraoperative blood loss(134.48±21.89)ml,postoperative hidden blood loss(790.15±89.84)ml,total bleeding volume(924.63±91.55)ml,postoperative Partial weight-bearing time(8.93±1.30)w,postoperative complete weight-bearing time(13.21±1.55)w,fracture healing time(17.71±1.65)w,the difference was statistically significant(P<0.05);The HHS of outer wall intact group(87.53±5.62)was higher than the outer wall dangerous group(83.71±7.82),and the difference between the two groups was statistically significant(P<0.05);but the excellent rate of HHS in the outer wall intact group(86.11%)And the excellent and good rate of HHS(72.41%)in the outer wall danger group(P>0.05);the thickness of the complete outer wall measured by X-ray before surgery was(28.47±3.49)mm,and the thickness of the outer wall dangerous group was(21.33±2.30)mm,and the difference was statistically significant(P<0.05).There were no significant differences in perioperative complications(intraoperative lateral wall fractures,incision infections,deep venous thrombosis of the lower limbs,pulmonary infections,and delirium)between the two groups(P>0.05).(Hip varus deformity,screw cutting,and postoperative hip pain)were not statistically significant(P>0.05).Conclusion:The efficacy of PFNA in the treatment of intact lateral wall fractures and outer wall dangerous femoral intertrochanteric fractures is shorter in the postoperative hospital stay,with less intraoperative blood loss,hidden blood loss,and total blood loss.Recovery time is short.Regardless of the type of intertrochanteric fracture,good perioperative management,correct intraoperative procedures,and reasonable postoperative rehabilitation exercises are the keys to a good prognosis. |
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