Analysis Of The Effect Of PFNA In The Treatment Of Femoral Intertrochanteric Fracture With Or Without Lateral Wall Injury

Objective:To analyze whether the effect of proximal femoral anti-rotation intramedullary nail（PFNA）in the treatment of femoral intertrochanteric Fractures（IFF）is related to the integrity of the lateral wall of the femur（hereinafter referred to as the lateral wall）.Method:The clinical data of IFF patients admitted to our hospital and treated with PFNA from September 2019 to March 2021 were retrospectively analyzed.According to the imaging data such as preoperative DR plain film,3D-CT,intraoperative film and postoperative DR plain film,judge whether the lateral wall is damaged.All cases were divided into intact lateral wall group and injured lateral wall group（including iatrogenic lateral wall injury）.According to the inclusion and exclusion criteria selection case,collect relevant data of patients finally included in this study.Baseline data included gender,age,height,weight,and basic diseases（hypertension,diabetes）;intraoperative data included blood loss,operation time and incision length;postoperative data included hospital stay,TAD,incision infection and long-term bed complications（DVT,pressure ulcer,urinary and respiratory infection,etc.）;the discharge follow-up data included Harris hip function score（HHS）at 1,3,6 and 12 months after operation and complications of internal fixation（fracture malunion,spiral blade cutting out or withdrawal,distal femoral fracture and delayed healing,etc.）.The relevant data between the two groups was statistically analyzed to explore the relationship between the integrity of lateral wall and the effect of PFNA.Result:Finally,a total of 87 patients were enrolled in this study,including44 cases in the intact lateral wall group and 43 cases in the injured lateral wall group（including 8 cases of iatrogenic lateral wall injury）.Statistical analysis and comparison of baseline data between the two groups,P>0.05,the difference was not statistically significant.Statistical analysis and comparison of hospital stay,incision infection,number of long-term bed complications（incidence）,postoperative TAD and HHS 1 month after operation between the two groups,P>0.05,with no statistical significance;Statistical analysis and comparison of operation time,intraoperative blood loss,incision length and the number of internal fixation complications（incidence）between the two groups,P<0.05,the difference was statistically significant;Statistical analysis and comparison of HHS at 3,6 and 12 months after operation between the two groups,P<0.05,the difference was statistically significant.The excellent rate of HHS 6 months after operation was 81.82%in the intact group and 51.16%in the injured group,statistical analysis results wasc~2=9.197,P<0.05,the difference was statistically significant.The excellent rate of HHS 12 months after operation was 97.73%in the intact group and 81.40%in the injured group,statistical analysis results wasc~2=4.617,P<0.05,the difference was statistically significant.Conclusion:The effect of PFNA in the treatment of IFF is closely related to the condition of the lateral wall,and the surgical effect of the intact lateral wall group is better than that of the injured lateral wall group.During the operation,the lateral wall should be actively protected to avoid iatrogenic injury.Restoration or rebuild the lateral wall if necessary,and pay attention to the prevention and treatment of related complications after operation.