Effect Of Anterior Cortex Positive Support Reduction On The Postoperative Efficacy Of PFNA Internal Fixation For Type 31-A2 Intertrochanteric Fractures

BackgroundIn the clinical treatment of unstable intertrochanteric fracture,since the concept of positive support of the medial cortex was proposed,through a large number of imaging,biomechanical data studies and clinical practice analysis,it has been confirmed that the reduction of positive support of the medial cortex can greatly reduce the occurrence of common postoperative complications in patients with unstable intertrochanteric fracture.But imaging studies have found that in intraoperative medial cortex reached only positive or neutral support of patients,postoperative after 3-D CT reconstruction found that there are still some patients with head and neck bone block sliding and lose the support of the medial cortex reset,and intraoperative medial cortex and cortex of the side reached positive support or neutral support of patients with postoperative support reduction and more stable.ObjectiveTo investigate the effect of proximal femoral nail anti-rotation(PFNA)internal fixation on intertrochanteric fractures of type 31-A2 with anterior cortex support reduction.MethodsA total of 78 patients with intertrochanteric fractures,including 32 males and 46 females,were admitted to the department of orthopedics of trauma of Henan provincial people's hospital between January 2017 and June 2019,and their average age was 74.0 years.According to the collection of positive and lateral hip X-ray of the patients 2 days after surgery,and by observing the contrapuntal relationship of the anterior cortex in their lateral X-ray,they were divided into three groups,namely,the positive supportive group(10 cases),the neutral supportive group(42 cases),and the negative supportive group(26 cases).Differences in gender,age,fracture typing,TAD value,changes in femoral neck stem Angle length and femoral neck length of the affected limb 2 days and 3 months after surgery,and hip joint Harris score 6 months after surgery were analyzed.ResultsThere were no statistically significant differences in gender,age,fracture typing,and TAD values among the three groups(P>0.05).The average length loss of femoral neck in the anterior cortical positive support group,the anterior cortical neutral support group,and the anterior cortical negative support group were 1.1mm,3.3mm,and 7.46 mm in two days and three months after surgery.The mean femoral neck trunk Angle loss was 0.8°,2.1° and 4.9°,respectively,in the group with positive anterior cortical support,the group with neutral anterior cortical support,and the group with negative anterior cortical support.The mean Harris score 6 months after the operation was 88.40±0.84 points,86.55±1.25 points and 84.54±1.24 points in the positive,neutral and negative support groups of the anterior cortex,respectively(P<0.01).The three groups were compared as a whole and in pairs,and the differences in femoral neck length loss,femoral neck shaft Angle loss and Harris score 6 months after surgery were statistically significant(P<0.01).ConclusionThe anterior cortex is of great significance in the internal fixation treatment of intertrochanteric fractures of femur.If the anterior cortex is reduced with negative support,even if the medial cortex is reduced with positive support,it will face extremely high reduction loss after surgery.The anterior cortical positive supportive reduction can provide a more stable supportive reduction of head and neck bone and femoral shaft,facilitate the recovery of postoperative hip function,and reduce the occurrence of postoperative complications such as helical blade cutting-through,cutting-out and hip coxa vara.