| Objective: To investigate the effects and safety of Proximal Femoral nail anti-rotation(PFNA)fixation and Hemi-Arthroplasty(HA)in treating unstable intertrochanteric fractures in obese elder patients,provide proposal for clinical practice.Method: 102 obese elderly patients diagnosed with unstable intertrochanteric femoral fractures were recruited in Huaihe Hospital of Henan University from September 2018 to September 2020.Based on the inclusion and exclusion criteria,65 obese elderly patients were included and divided into two groups according to the surgical procedure:the PFNA group and the HA group.There were 31 patients in the PFNA group(male : female=11:20),the average age was 79.06 years old,meanwhile 34 patients in the HA group(male : female=12:22),and the average age was 79.59 years old.The general data,operative time,overall blood loss,apparent blood loss,hidden blood loss,postoperative weight-bearing time,length of hospital stay,and complications of the two groups were analyzed and summarized,Harris score and EQ-5D-5L score were used to evaluate the function of hip joint 2,12,24 and 48 weeks after surgery.Results: The comparison and analysis of basic information(gender,age,underlyging diseases,BMI value,fracture typing,and ASA classification)between the two groups showed no significant differences(P>0.05).The length of hospital stay was(15.87 ± 5.01)d in the PFNA group and(17.24 ± 4.38)d in the HA group,with no significant difference(P>0.05);the duration of surgery was(72.10±16.92)min in the PFNA group and(78.97±21.21)min in the HA group,with no significant difference between the two groups(P>0.05);the postoperative time until the start of weight-bearing exercise was(39.16±1.88)d in the PFNA group and(3.00±0.55)d in the HA group(P<0.05).In terms of blood loss,the total blood loss of patients in the PFNA group was(944.80 ± 138.40)ml,(808.90 ± 76.21)ml in the HA group(P<0.05);the apparent blood loss in the PFNA group was(228.80 ± 61.80)ml,(353.70 ± 106.00)ml in the HA group(P<0.05);the hidden blood loss in the PFNA group was(716.00 ± 121.10)ml,(455.20 ± 103.90)ml in the HA group(P<0.05).Complications within two weeks after surgery,there were a total of 10 cases in 6 patients,8 cases in 4 patients in the PFNA group,3 cases of lower extremity deep vein thrombosis,1 case of decubitus ulcer,1 case of gastrointestinal discomfort,1 case of skin rash,and 2 cases of pendant pneumonia,and 2patients in the HA group,both of them had delayed wound healing;there were 3 patients with long-term postoperative complications,including 1 case of nonunion in PFNA group,1 case of dislocation and 1 case of periprosthetic fracture in HA group.The Harris score at 2 weeks postoperatively was(14.02±3.78)in the PFNA group and(38.93±1.09)in the HA group(P<0.05);at 12 weeks postoperatively,the Harris score was(50.32±3.62)in the PFNA group and(60.56±2.43)in the HA group(P<0.05);at 24 weeks postoperatively,the Harris score was(73.31±2.01)in the PFNA group and(75.10±2.59)in the HA group(P<0.05);at 48 weeks postoperatively,the difference between the Harris score of the two groups was not significant(P>0.05);2weeks after surgery,the functional outcome in Harris score was(0)in the PFNA group and(12.03 ± 1.03)in the HA group(P<0.05);12 weeks after surgery,the functional outcome in Harris score was(15.03 ± 1.91)in the PFNA group and(23.03 ± 2.42)in the HA group(P<0.05);at 24 weeks postoperatively,the functional outcome in the Harris score was(25.10 ± 1.96)in the PFNA group and(27.12 ± 2.64)in the HA group(P<0.05);at 48 weeks postoperatively,there was no significant difference in the functional scores of the Harris score between the two groups(P>0.05).EQ-5D-5L score at 2 weeks postoperatively was(0.129 ±0.03)in the PFNA group and(0.260 ± 0.02)in the HA group(P<0.05);at 12 weeks postoperatively was(0.327± 0.05)in the PFNA group and(0.403 ± 0.05)in the HA group(P<0.05);EQ-5D-5L score was(0.611±0.06)in the PFNA group and(0.649±0.07)in the HA group at 24 weeks postoperatively(P<0.05);at 48 weeks postoperatively,EQ-5D-5L score difference was not statistically significant(P > 0.05).Conclusion: In conclusion,PFNA fixation can preserve the bone tissue of patients to the maximum extent,which is more in line with the normal physiological state in biomechanics,and has a good treatment effect in 48 weeks.HA can immediately reconstruct the hip joint function of the patients,which is beneficial to the recovery of the joint function,get out of bed early,avoid the complications of bed rest,accelerate the recovery of the patients,and has a good effect on the unstable intertrochanteric fracture in the elderly obese patients. |
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