Comparative Efficacy Of Proximal Femoral Nail Antirotation And Anatomic Proximal Femoral Locking Plate For The Treatment Of Intertrochanteric Fractures

Object: To compare the clinical results of intertrochanteric fractures using proximal femoral nail antirotation(PFNA) and anatomic proximal femoral locking plate(ALP).Method: A review study was conducted on 71 patients of inter- trochanteric fractures treated with PFNA and ALP in Baoding Orthopaedic Hospital and Affiliated Hospital of Hebei University from January 2011 to January 2014. 42 patients were followed up successfully. According to the AO/OTA classification,22 cases treated with PFNA(stable type:10 cases; unstable type:12 cases) and 20 cases with ALP(stable type:10 cases; unstable type:10 cases). We evaluated operation time, incision length, intra-operative bleeding, post-operative weight bearing-time, post-operative complications, hospitalization time, amount of blood transfusion in hospital, healing time of fracture in the two groups. Record the hip functions recovery(Harris score) and Activities of Daily Living Assessment(ADL score) after 1month, 3 months, 6 months, and 12 months postoperatively. Finally, we processed the data by statistical software, and compared with the effects of two surgical procedures.Results: The 42 cases were followed up successfully with a mean period of 24.5(12 to 36) months. and no patient were lost. All data were statistically analyzed by the software of SPSS19.0.(1) The comparison of pre-operative and intra-operative : There were significant differerces between the two group in comparison of sex, age, fracture type,and Singh Index(P>0.05).There were significant differerces between the two group in comparison of operation time, incision length, intra-operative bleeding(P<0.05).There were no significant differerces between the two group in comparison of hospitalization time(P>0.05).(2) The comparison of postoperative: There were significant differerces between the two group in comparison of post-operative weight bearing-time, post-operative full weight bearing-time, and healing time of fracture(P<0.05). There were no significant differerces between the two group in comparison of amount of blood transfusion in hospital(P>0.05).(3) The comparison of the hip functions recovery(Harris score): There were no significant differerces between the two group in comparison of Harris scores before the injury(P>0.05). There were significant differerces between the two group in comparison of Harris scores after 1 month and 3 months postoperatively(P<0.05). There were no significant differerces between the two group in comparison of Harris scores after 6 months and 12 months postoperatively(P>0.05).(4) The comparison of ADL score: There were no significant differerces between the two group in comparison of ADL score before injury(P>0.05). There were significant differerces between the two group in comparison of ADL score after 1 month and 3 months postoperatively(P<0.05). There were no significant differerces between the two group in comparison of ADL score after 6 months and 12 months postoperatively(P> 0.05).(5) The comparison of the rate of optimal and good: There were significant differerces between the two group in comparison of the rate of optimal and good after 1 month and 3 months(P<0.05). There were no significant differerces between the two group in comparison of the rate of optimal and good after 6 months and 12 months(P>0.05).(6) The comparison of post-operative complications: There were significant differerces between the two group in comparison of hip varus and internal fixation loosening(P<0.05). There were no significant differerces between the two group in comparison of other related complications(P>0.05). There were significant differerces between the two group in comparison of the general complications(P<0.05).Conclusions:1 Two different fixation methods for intertrochanteric fractures can achieve good clinical effect with their own characteristics.There were no significant differerces between the two group in comparison of hospitalization time,amount of blood transfusion in hospital, Harris scores after 3 months,6 months,and 12 months postoperatively.2 In comparison,PFNA can achieve shorter incision length,shorter operative time, less blood loss,more simple operation,more reliable fixation,and earlier weight beating.3 The short-term curative effect of PFNA is gooder than ALP. The complications of ALP is more than PFNA,but there were no significant differerces between the two group in comparison of the curative effect of long term.