| Purpose: Comparative analysis of the clinical effects of proximal femoral nail antirotation(PFNA)or artificial femoral head replacement(AFHR)in the treatment of elderly unstable intertrochanteric fractures(ITF).Methods: We retrospectively analyzed the clinical case data of patients with unstable intertrochanteric fractures of the elderly(≥80 years old)who were treated with PFNA or artificial femoral head replacement in the Department of Orthopedics of the Affiliated Hospital of Yan’an University from June 2017 to December 2020.63 cases meeting the criteria of nadir were used as study subjects,37 males and 26 females in total;according to Evans-Jensen’s typing According to Evans-Jensen’s staging: 13 cases of type III,35 cases of type IV,and 15 cases of type V.Based on the difference of surgical treatment,the patients were divided into PFNA group with proximal femoral nail antirotation and AFHR group with artificial femoral head replacement for statistical analysis.Statistical processing of general data such as gender,fracture type,and age of patients in the PFNA and AFHR groups showed that the differences between the groups were not statistically significant(P>0.05),and the PFNA and AFHR groups were comparable.The clinical observation index was to compare the intraoperative operation time,the total number of fluoroscopic views during surgery,the intraoperative wound bleeding,the time of starting to get out of bed for weight-bearing walking after surgery,and the effective follow-up of the patients’ Harris score results and excellent rate at 6 months after surgery to assess the functional recovery of the hip joint after surgery,and all data were collated and evaluated for statistical comparison.Results: The operative time(46.00±7.08)min and intraoperative bleeding volume(79.68±23.45)ml in the PFNA group were less than those in the AFHR group(64.16±9.03)min and intraoperative bleeding volume(257.81±50.97)ml in both groups(P<0.001);however,the number of intraoperative fluoroscopies(2.72±0.81)times and the time to start walking with weight in bed(2.56±0.62)d in the AFHR group were significantly better than those in the PFNA group(6.71±1.62)d.However,the number of intraoperative fluoroscopy(2.72±0.81)times and the time to start walking with weight in bed after surgery(2.56±0.62)d were significantly better in the AFHR group than in the PFNA group(6.71±1.04)times and the time to start walking with weight in bed after surgery(30.29±2.33)d(P<0.001);in addition,the effective postoperative follow-up of 63 patients from 6 to 12 months It was found that although there was no difference(P>0.05)by comparing the Harris score and excellent rate in the PFNA group(85.68±6.62;87.1%)with the AFHR group(88.75±6.58;87.5%)at 6 months postoperatively,the incidence of postoperative complications in both groups was analyzed to be lower in patients in the AFHR group(6.3%)than in the PFNA group(29.0%)(P<0.05).Conclusion: Combined with the comprehensive analysis of the results of the two groups of data in this study,we can see that both artificial femoral head replacement and PFNA are suitable as surgical interventions for patients with unstable intertrochanteric fractures in elderly(≥80 years),and both can effectively improve the hip function of the patients,although PFNA is relatively less traumatic for the patients,but artificial femoral head replacement has more advantages in early postoperative rehabilitation and lower complication rate,so it is more worthy of clinical application. |
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