| Objective:Through the comparative study of proximal femoral nail anti-rotating(PFNA)and artificial femoral head replacement(FHR)in the treatment of femoral intertrochanteric fracture in elderly patients,to analyze the difference of clinical efficacy between the two,and to provide the basis for clinical choice of surgical methods.Methods:Medical records of 76 patients(aged 75-98 years)with intertrochanteric fractures admitted to the first affiliated hospitai of anhui university of science and technology from march 2019 to february 2020 were selected.According to different surgical methods,the patients were divided into PFNA group and FHR group.There were 42 patients in PFNA group,including 20 males and 22 females;Age:75-92 years,average(81.95±6.08)years;There were 25 cases on the left side and 17 cases on the right side;Causes of injury:fall injury in 25 cases,traffic injury in 13 cases,other 4 cases;The time between admission and operation was 2-7 days,with an average(4.05±1.71)days;Complicated with medical diseases:13 cases of coronary heart disease,11 cases of hypertension,8 cases of diabetes,4 cases of bronchopneumonia,6 other cases.There were 34 cases in the FHR group,including 16 males and 18 females;Age:75-98 years,average(81.32±6.93)years;Left side 16 cases,right side 18 cases;Causes of injury:fall injury in 19 cases,traffic injury in 12 cases,other 3 cases;The time between admission and operation was 2-6 days,with an average(4.50±1.33)days;Complication of medical diseases:11 cases of coronary heart disease,7 cases of hypertension,6 cases of diabetes,3 cases of bronchopneumonia,7 cases of other.According to the latest AO classification(2018 edition),the results were as follows:PFNA group,16 cases of A1.2 type,15 cases of A1.3 type,8 cases of A2.2 type and 3 cases of A2.3 type;FHR group,13 cases of A1.2 type,15 cases of A1.3 type,5 cases of A2.2 type and 1 case of A2.3 type.According to the different surgical methods,the time between admission and operation,the total length of incision,the duration of postoperative hospital stay,the operative time,intraoperative blood loss,the decrease of hemoglobin value 3 day after surgery,the degree of pain 3 days after operation,postoperative walking time,harris score of hip joint 1 month,6 months and 12 months after operation,,hip function between the two groups at the last follow-up,postoperative complications(incision infection,pulmonary infection,inferior deep vein embolism,cardio-cerebrovascular accident,etc.)were compared between the two groups.Results:The time between admission and operation was(4.05 ± 1.71)days in PFNA group and(4.50±1.33)days in FHR group,with no significant difference between the two groups(P>0.05);The total length of incision was(7.24±1.09)cm in PFNA group and(10.08± 1.76)cm in FHR group,with significant difference between the two groups(P<0.05);The duration of postoperative hospital stay was(6.34 ± 2.09)days in PFNA group and(7.07±1.12)days in FHR group There was no significant difference between the two groups(P>0.05),The operative time in PFNA group(56.81 ± 13.65min)and FHR group(67.55±16.18min)was significantly different between the two group(P<0.05);Intraoperative blood loss in PFNA group(145.96±25.64ml)and FHR group(302.57±80.91ml)was statistically significant(P<0.05);There was no significant difference in the decrease of hemoglobin level between in PFNA group(22.81±5.35ml)and the FHR group(24.19±4.95ml)3 days after the surgery(P>0.05);Three days after operation,the VAS score of PFNA group and FHR group was(3.68+1.81)and(2.06+1.22).There was significant difference between the two groups(P<0.05);Postoperative time to the ground:PFNA group(8.33± 1.82 days)and FHR group(3.54± 1.25 days)had statistically significant differences(P<0.05);One month after surgery,Harris scores of the hip joint in the PFNA group(51.36±8.81 points)and the FHR group(76.35±5.19 points)were statistically different between the two groups(P<0.05);Six month after surgery,Harris scores of hip joints in the PFNA group(82.37±5.66 points)and FHR group(84.16±4.34 points)showed no significant difference between the two groups(P>0.05);Harris score of hip joint 12 months after operation,PFNA group(84.65+7.67points),FHR group(83.91+9.35 points),there was no significant difference between the two groups(P>0.05);There was no significant difference in hip function between the two groups at the last follow-up(P>0.05);Postoperative complications were found in PFNA group(incision infection in 2 cases,pulmonary infection in 1 case,deep vein embolism in lower extremity in 0 cases,cardiovascular and cerebrovascular accident in 2 cases),FHR group(incision infection in 1 case,pulmonary infection in 1 case,deep vein embolism in lower extremity in 1 case,cardiovascular and cerebrovascular accident in 1 case).There was no statistical difference between the two groups(P>0.05).Conclusions:PFNA and FHR are two effective methods for the treatment of intertrochanteric fracture in elderly patients.The long-term effect of the two methods is not significantly different.In the total length of incision,operation time and intraoperative blood loss,PFNA is less than FHR,which indicates that PFNA has less trauma to human body than FHR..However,the time to go to the ground after operation,VAS score 3 days after operation and Harris hip score 1 month after operation in FHR group were better than PFNA,FHR allowed patients to move to the ground early,and the pain feeling of patients after operation was better than PFNA.Doctors should choose appropriate treatment methods according to the physical fitness of patients,different types of fractures and tolerance to surgery. |
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