Effect Of Different Surgical Methods On Intertrochanteric Fracture Of Femur In Elderly Patients

Research purpose Intertrochanteric fracture of femur is one of the fractures with the highest incidence in the elderly.There are many kinds of surgical treatment,but it is not clear which one is more effective.By retrospective analysis,this study compared the effects of four common internal fixation methods: Proximal Femoral Nail Anti-rotation Ⅱ(PFNA-II),Gamma3(TGN),Inter Tan(IN)and Proximal Femoral Locking Plate(PFLP),so as to provide a basis for emergency surgeons to select surgical methods.Research method 1.A total of 250 elderly patients with intertrochanteric fracture of femur combined with osteoporosis who were admitted to our hospital and treated with the above four internal fixation methods were included in this study.There were 69 males and 181 females.The mean age was 80.5 years.There were 196 cases of 31-A2 type and 54 cases of 31-A3 type.According to different surgical methods,patients were divided into four groups: 137 patients in PFNA-II group,35 patients in TGN group,38 patients in IN group,and 40 patients in PFLP group.2.Preoperative data: AO classification of fracture,preoperative anaesthesia ASA rating,proximal femoral trabecular index(FTPI)classification,preoperative medical complications and postoperative waiting time.3.Comparison of intraoperative conditions: operation time,intraoperative blood loss and intraoperative blood transfusion.4.Comparison of prognosis: 1-year postoperative mortality,Harris score,FRS score,incidence of internal systemic complications,and incidence of local complications of fracture.5.Statistical treatment: SPSS 20.0 software was used for statistical analysis,and P<0.05 was defined as statistically significant.Research results 1.There was no significant difference in AO classification of fracture,preoperative ASA rating,FTPI classification,preoperative medical complications,and preoperative waiting time between the four groups(p>0.05).2.There was no significant difference in intraoperative blood transfusion volume between the four groups(p>0.05),and the difference in operative time and intraoperative blood loss was statistically significant(p <0.05).The operative time of PFNA-II group was shorter than that of IN group and PFLP group(p<0.05);Intraoperative blood loss IN pfna-ii and TGN groups was lower than IN group(p<0.05).3.The total number of days of hospitalization,postoperative mortality,incidence of complications in general internal medicine,and incidence of local complications in the four groups showed no significant difference(p>0.05).Harris and FRS scores were significantly different one year after surgery(P<0.05),and the two scores in pairwise comparison were lower than those in the other three groups(P<0.05).4.Logistics regression showed that age and surgical method were related factors influencing Harris and FRS score(p<0.05),regardless of gender(p>0.05).Further analysis of variance by age group showed that two scores in the PFLP group at the age of 65 to 81 years were still lower than the other three groups(P<0.05),while two scores at the age of 82 to 99 years showed no statistical difference(P >0.05).Research conclusions(1)PFNA-II,IN and TGN are recommended for the treatment of elderly patients with intertrochanteric fracture of the femur aged 65 to 81 years with osteoporosis if the condition is relatively mild(such as no preoperative medical disease,ASA grade I-II,FTPI grade 3-4).In the three types of intramedullary fixation,if IN has been applied more mature,it may consider as the first choice;Otherwise PFNA-II and TGN are recommended.(2)Patients aged 82 to 99 years with severe illness(such as preoperative combination of multiple medical diseases,ASA grade III,FTPI 1-2)were recommended for PFLP treatment.