Clinical Observation Of Proximal Femoral Nail Antirotation In The Fixation Of Senile External Wall Intact Or External Wall Fracture Type Intertrochanteric Fracture

Objective: To analyze retrospectively the relationship between senile lateral wall fracture and lateral wall risk femoral intertrochanteric fracture.The clinical effect of intramedullary nail(PFNA)on the treatment of senile unstable intertrochanteric fracture of femur was discussed.The clinical significance of the lateral wall of femoral intertrochanteric wall was deeply understood.Methods: Retrospective analysis of 74 cases of senile unstable intertrochanteric fractures treated with PFNA from January 2015 to December 2017 in the First Affiliated Hospital of Hainan Medical College.The intertrochanteric fractures were divided into group A according to the type of fracture.Primary lateral wall fracture type)and group B(external side wall risk type);25 cases in group A,8 males and 17 females,aged 67-95 years,mean 82.6±8.1 years;group B 49 cases,male 15 For example,34 females,aged 66-93 years,averaged 80.7 ± 7.4 years.According to the X-ray films,the risky femoral intertrochanteric fractures in the lateral wall were divided into B1 group(intraoperative iatrogenic lateral wall fracture)and B2 group(without intraoperative lateral wall fracture);9 cases in B1 group,male 3 For example,6 females,aged 67-93 years,mean 78.8 ± 8.7 years;40 patients in B2 group,12 males and 28 females,aged 66-93 years,mean 81.2 ± 7.1 years old.Compare gender,age,length of surgery,intraoperative blood loss,length of hospital stay,length of fracture reduction,TAD,partial weight and total weight-bearing time after surgery,fracture healing time,neck dry angle loss,eccentricity shortening The difference between Harris scores at 1 year follow-up was compared.The gender,age,length of surgery,intraoperative blood loss,length of hospital stay,quality of fracture reduction,TAD,partial weight after surgery and total weight-bearing time were compared between the two groups.The difference between fracture healing time,lateral wall thickness,neck stem angle loss,eccentricity shortening,and Harris score after 1 year follow-up.Results: There were no significant differences in gender distribution,age,fracture reduction quality,and TAD between the groups(P<0.05).Group A operation time(99.8±27.5)min,intraoperative blood loss(233.6±56.1)ml,length of hospital stay(21.0±5.8)d;group B operation duration(66.2±9.1)min,intraoperative blood loss(184.9 ± 25.9)ml,hospitalization duration(15.9 ± 3.3)d;operation time,intraoperative blood loss,hospitalization The differences were statistically significant(P<0.05).The length of operation in group B1 was(69.8±10.6)min,the amount of intraoperative blood loss was(190.6±40.7)ml,and the length of hospitalization was(16.0±3.6)days.The length of operation in group B2 was(65.4±8.6)minutes,and the amount of intraoperative blood loss was(183.6±21.9).)ml,length of hospital stay(15.8 ± 3.3)days;there was no significant difference between the two groups in terms of length of surgery,intraoperative blood loss,and length of hospital stay(P>0.05).Part A weight-bearing time(10.6 ± 1.9)weeks,complete weight-bearing time(13.7±1.8)weeks,fracture healing time(16.2±1.6)weeks,partial load-bearing time of group B(8.5±1.4)weeks,complete weight-bearing time(11.5± 1.3)Week and fracture healing time(14.4 ± 1.2)weeks;the difference of weight and total weight-bearing time and fracture healing time between the two groups were statistically significant(P<0.05).Partial weight-bearing time(9.9 ± 1.2)weeks,complete weight-bearing time(12.8±1.2)weeks,fracture healing time(15.4±1.1)weeks in B1 group,partial weight-bearing time(8.2 ± 1.2)weeks in B2 group,complete weight-bearing time(11.2± 1.1)Week,fracture healing time(14.3 ± 1.1)weeks;the weight loss and total weight-bearing time and fracture healing time between the two groups were statistically significant(P<0.05).The thickness of the outer wall of group B1 was(21.52 ±3.23)mm;the thickness of the outer wall of group B2 was(27.02±4.24)mm;the thickness of the lateral wall of the two groups was statistically significant(P<0.05).Group A neck loss angle(3.88 ± 0.93)°,eccentricity shortening(5.60 ± 2.33)mm;group B neck dry angle loss(2.33 ±1.27)°,eccentricity shortening(3.71±1.78)mm;The differences were statistically significant(P<0.05).B1 group neck loss angle(3.33 ± 1.23)degrees,eccentricity shortening(5.11±1.76)mm;B2 group neck dry angle loss(2.10±1.17)degrees,eccentricity shortening(3.40 ± 1.65)mm;Patients with neck dryness loss and eccentricity shortening distance were compared,the difference was statistically significant(P<0.05).The excellent and good rate of Harris scores in group A and group B were 72.0% and 91.8%,respectively.The difference between the two groups was statistically significant(P<0.05).The excellent and good rate of Harris scores in the B1 and B2 groups were 77.8% and 95.0%,respectively.There was no significant difference between the two groups(P>0.05).Conclusion: Proximal femoral nail antirotation is effective in the treatment of senile lateral wall fractures and lateral wall risk of intertrochanteric fractures,but the fracture of the lateral wall can weaken the treatment effect.The external wall risk of intertrochanteric fractures is superior to the external wall fractures.For patients with external thoracic intertrochanteric fractures,the risk of intraoperative iatrogenic fractures is affected by the thickness of the lateral wall and the fracture classification.The fracture should be typed before surgery and the thickness of the lateral wall should be measured routinely.Care should be taken to protect the lateral wall to prevent iatrogenic lateral wall fractures.