Clinical Efficacy And Factors Influencing The Treatment Of Intertrochanteric Fractures In The Elderly With The Intramedullary Fixation

Objective: Any current treatment protocol for intertrochanteric fractures in the elderly still cannot fully restore hip function to pre-fracture levels in all patients.Therefore,it is hypothesized that there are many factors other than the surgical protocol,the position of the internal fixation and the repositioning situation that affect the outcome of intertrochanteric fractures in the elderly.This article examines the factors that influence the recovery of hip function after intramedullary fixation for intertrochanteric fractures,in order to provide a theoretical basis for clinical practice and to take targeted measures to improve the prognosis.Methods: Patients with intertrochanteric fractures of the femur treated with third-generation gamma nail and PFNA-II at the First Affiliated Hospital of Kunming Medical University from December 2019 to January 2022 were collected and counted for gender,age,BMI,preoperative ASA grading,fracture subtype,time from injury to surgery,anesthesia,choice of internal fixation,duration of surgical operation,intraoperative blood loss,postoperative change in neck stem angle,pain in the operative area,Clavien Dindo classification,duration of protective weight bearing,total blood loss,albumin level at discharge,and whether or not rehabilitation unit treatment may affect postoperative functional recovery.The level of functional recovery of the hip at 3 months after surgery was assessed using the Harris scoring system,with scores ≥80 included in the satisfactory outcome group and scores <80included in the unsatisfactory outcome group.SPSS 25.0 was used to analyse the data using t-test,chi-square test,and binary logistic regression to analyse the data and find the influencing factors from them.Results: A total of 150 patients were included in the study,of whom 53 were male and 97 were female.There were 109 patients(72.67%)in the satisfactory outcome group and 41 patients(27.33%)in the unsatisfactory outcome group.The results of the univariate analysis showed that there were statistically significant differences between the two groups in terms of BMI,ASA classification,fracture typing,time from injury to surgery,Clavien-Dindo classification,duration of protective weight bearing,albumin level at discharge,and the presence of rehabilitation unit treatment(p < 0.05),while the differences between the groups in terms of gender,age,type of anaesthesia,internal fixation,postoperative change in neck stem angle,intraoperative blood loss,operative There was no statistically significant difference between groups in terms of gender,age,anesthesia,internal fixation,change in postoperative neck stem angle,intraoperative blood loss,duration of operation,hip pain,and total blood loss(P > 0.05).Binary logistic regression analysis of the influencing factors showed that: higher BMI,longer time from injury to surgery,higher ASA classification,unstable fracture typing,later dismounting,and higher Clavien Dindo classification were risk factors for postoperative functional recovery(P < 0.05,OR > 1);higher discharge albumin level and the presence of rehabilitation unit treatment were protective factors for postoperative functional recovery(P <0.05,OR <1).Conclusion: The recovery of function after surgery for inter-rotor fractures in the elderly is influenced by a number of factors,including BMI,time from injury to surgery,ASA classification,fracture staging,protective weight-bearing time,discharge albumin level,and Clavien-Dindo classification for rehabilitation unit treatment.Active scientific and rational intervention of controllable factors will result in significant improvements in functional recovery and quality of life.