The Effect Of Fracture Reduction With Positive Medial Cortical Support On PFNA In Intertrochanteric Fractures

Objective To compare and analyze the effect of positive medial cortical support on the effect of PFNA(proximal femoral antirotation intramedullary nail)in intertrochanteric fractures,and to seek the ideal reduction method and provide reference for clinical treatment.Methods A retrospective analysis of third affiliated hospital of anhui medical university(the hefei first people's hospital)between January 2017 and January 2019 with proximal femoral anti-rotation intramedullary nail treatment of intertrochanteric fractures,(AO/OTA31A2 type),a total of 113 cases of 43 cases of male,female accounted for 70 cases,age distribution from 59 to 91 years old,with an average age of 72.43 years.Based on intraoperative X-ray is taken in the femoral head and neck piece of medial cortical bone with the femoral proximal medial cortex,the relative position between the lines by PFNA treatment of femoral fracture patients are divided into three groups,between the rotor head and neck bone block above the medial to the femoral proximal medial cortex cortex for positive support group,both the medial cortex under X-ray anatomy reset to neutral,head and neck bone blocks medial to the femoral proximal medial cortex cortex of above is negative.The number of cases in the positive support group was 75,including 28 males and 47 females,with an average age of 73.0 years.There were 21 cases in the neutral support group,including 8 males and 13 females,with an average age of 70.7 years.The number of cases in the negative support group was 17,including 7 males and 10 females,with an average age of 72.0 years.By comparing the three groups of patients with the time of full load after surgery,six months after surgery with the loss of femoral neck length and cervical trunk Angle immediately after surgery,and the hip Harris score at six months after surgery,complications,the influence of different support methods on the surgical effect was understood.Results All patients were fully followed up for 8 to 14 months,averaging 10.6 months.All patients were healed in the first stage,without incision dehiscence,fracture nonunion or delayed healing,and no death during follow-up.There was no significant difference among the three groups in gender,age,operation time,intraoperative blood loss,number of cases with peak distance less than 25 mm and other general data,P>,0.05,indicating comparability.The neck-stem Angle of the positive support group,the neutral support group and the negative support group were 0.76°±0.2°,4.23°±1.05° and 8.81°±0.98°,respectively.The postoperative loading time of patients in the three groups was 34.04±3.51 days,35.19±3.96 days and 53.18±5.34 days,respectively.The positive group was compared with the neutral group(t=-1.291,p=0.2),showing no significant statistical significance.The positive group was compared with the negative group(t=-18.277,p <0.01),showing significant statistical significance.The shortened length of femoral neck was 2.3mm±0.55 mm,3.49mm±0.58 mm,and 6.36mm±0.92 mm,respectively.The positive group was compared with the neutral group(t=-8.619,p<0.01),which was statistically significant.The positive group was compared with the negative group(t=-23.897,p<0.01),which was statistically significant.Harris score of hip joint was 88.84±2.94,85.38±3.44,83.94±2.93,respectively,the positive group was compared with the neutral group(t=0.315,p<0.01),and the positive group was compared with the negative group(t=6.207,p<0.01).The number of postoperative complications was 2,2 and 3,respectively,and the comparison between the positive group and the negative group was statistically significant(p<0.05).Positive is supported,neutral,negative support three ways to reset,positive support compared with negative support,full weight-bearing time after surgery,the length of the femoral neck lost lost,neck stem Angle,Harris hip scores were significantly more advantage,complications,and compared with neutral support multiple index has obvious advantages,obtained the better surgical curative effect,achieving better surgical effect.Conclusion Although the positive supportive reduction of intertrochanteric fracture is non-anatomical reduction,it can make more stable contact between head and neck bone and femoral shaft,provide better biomechanical conditions for fracture healing,and improve the curative effect of intertrochanteric fracture.In the treatment of intertrochanteric fractures,positive support should be actively pursued under limited circumstances to facilitate the early recovery of patients.