Effect Of Three Kinds Of Support After Closed Reduction And PFN Internal Fixation For Intertrochanteric Fracture Of Femur

ObjectiveTo investigate the effect of closed reduction of proximal femoral intramedullary nail(proximal femoral nail,PFN)on the treatment of femoral intertrochanteric fracture with positive support,negative support and neutral support.MethodsRetrospective analysis of 90 cases of complex intertrochanteric fractures treated with closed reduction and internal fixation of proximal femoral intramedullary nail(PFN)in of our hospital from January 2014～ June 2019,60～88,average(74.98±6.82)years.According to the position relationship of the medial bone cortex of the fracture end in the anterior X line of hip joint after operation,it was divided into three groups :49 positive support group,25 negative support group and 16 neutral support group.A correlation analysis was carried out between the change value of cervical dry angle,spical distance,femoral neck length and Harris score after 1year;To compare the sex of the three groups,Age,Bone mineral density,Fracture type,1 year after operation,the change of apical distance(TAD),dry angle of neck,length of femoral neck,Excellent and good rate of hip function Harris score 1 year after operation,Internal fixation is inefficient.ResultsThe follow-up time was 12 to 15 months after operation,and4 people were lost.1.There was no significant difference in age,sex,fracture type and bone mineral density(P>0.05)between three groups;2.in the three groups of data,there was a weak negative correlation between the change value of apical distance and the Harris score(R=-0.388,P=0.001),a weak negative correlation between the change value of cervical dry angle and the Harris score after 1 year(R=-0.295,P=0.003),and a weak negative correlation between the change value of femoral neck length and the Harris score(R=-0.342,P=0.001);3.One year after the operation,the TAD value of neutral,positive and negative support group P<0.05,statistical difference(Positive,negative and neutral support values 1.22+0.22 mm 、 4.46+0.90 mm 、 1.34+0.44 mm),Compared with the negative support group,the change value of dry angle of neck was P<0.05,and the difference was statistically significant(Average change values of positive,negative and neutral support were 2.35+ 0.74、5.36+1.27、2.16 +0.59),Femoral neck length change value neutral,positive and negative support group P<0.05,statistical difference(The average change values of positive,negative and neutral support were 3.86+0.89 mm、6.86+1.81 mm、3.44+0.65 mm),The excellent and good rate of Harris score was P<0.05 compared with that of negative support group.(Positive,negative and neutral support groups:83.36%,72.25%,86.62%,respectively).4.negative support group showed 1 case of back nail,1case of broken nail,1 case of cutting to femoral head,the failure rate of internal fixation was 12.5%,There was no internal fixation failure in the positive and neutral support group.Among the three groups of support,the fracture of neutral and positive support group reached clinical healing,and the fracture healing rate reached 100%.The negative support group had 3 cases of fracture nonunion due to the appearance of back nail,cutting nail and broken nail during follow-up,and the fracture healing rate was 91.67%.Conclusion1.For the elderly intertrochanteric fracture,three kinds of support methods can promote fracture healing by using γ-Ⅱ type intramedullary interlocking nail closed reduction and internal fixation.Internal fixation is firm,complications are less,negative support should be avoided.2.After 1 year,the change of femoral neck length,the change of neck angle and the change of apical distance can affect the can affect the prognosis function of hip joint,and can be used as a reference index curative effect of PFN in the treatment of intertrochanteric fracture of femur.