| Objective:This study aims to comparative the effects of intertrochanteric-subtrochanteric fractures of the femur treated with proximal femoral locking plate(PFLP),reconstruction intramedullary nail(RIN)and proximal femoral nail anti-rotation(PFNA),and provide reference for clinical practice.Methods: The patients with intertrochanteric-subtrochanteric fractures of the femur treated in the Third Hospital of Hebei Medical University and Weichang People’s Hospital during March 2013 and March 2017 were retrospectively analyzed.The patients were classified into three groups according to the selected internal fixation,including PFLP group,RIN group and PFNA group.The sex,age,operation time,intraoperative blood loss and the length of all incisions of the patients were collected.Patients were followed up.The postoperative radiographs were taken to assess the union of fracture.The functional outcomes were assessed using the Harris score at the latest follow-up.The data were analyzed using SPSS to compare the clinical outcomes of intertrochanteric-subtrochanteric fractures of the femur treated using three different internal fixators.Results:During March 2013 and March 2017,68 patients with intertrochanteric-subtrochanteric fractures of the femur were treated and enrolled into this study.There were 20 patients in PFLP group and two patients were lost for follow up.The other 18 patients were followed up with an average duration of 28.7±5.5 months(range,18-40 months),including 8 males and 10 females with an average age of 71.0±3.5 years old(range,65-75 years).There were 11 left fractures and 7 right ones.The affected lower extremity were treated by skeletal traction before the operation for 2-7 days(3.3±1.5 on average).23 patients were enrolled in the RIN group and seven patients were lost for follow up.The other 16 patients were followed up with an average duration of 25.7±6.1 months(range,18-42 months),including 7 males and 9 females with an average age of 70.2±4.0 years old(range,65-75 years).There were 9 left fractures and 7 right ones.The affected lower extremity were treated by skeletal traction before the operation for 2-5 days(2.8±0.9 on average).25 patients were enrolled in the PFNA group and eight patients were lost for follow up.The other 17 patients were followed up with an average duration of 24.5±9.0 months(range,12-44 months),including 6 males and 11 females with an average age of 71.2±4.1 years old(range,66-75 years).There were 10 left fractures and 7 right ones.The affected lower extremity were treated by skeletal traction before the operation for 2-6 days(2.7±1.3 on average).There were no statistical difference among three groups on sex,age,fractured side,and the duration of preoperative traction(all P>0.05).All operations were completed without intraoperative complications.The average operation time,incision length,blood loss in PFLP group were 154.78±27.42 min,20.83±2.64 cm and 274.44±36.17 ml,respectively.The average operation time,incision length,blood loss in RIN group were 122.38±15.67 min,11.78±1.53 cm and 143.75±43.49 ml,respectively.The average operation time,incision length,blood loss in PFNA group were 44.35±4.21 min,8.47±0.62 cm and 94.00±24.49 ml,respectively.Statistical analysis shows that there were significant difference among the three groups in the issues of operation time,incision length and blood loss(P<0.01).By comparison between any two groups,the PFLP group has the longest operation time and incision length and most blood loss,which the PENA had the least values in each issue with significant difference(P<0.01).The fractures in PFLP group united on 16.2±2.5 weeks on average(range,13-24)after the operation with four cases sustaining complications including two cases of screw breakage,one case of delayed union of fracture and one case of superficial infection.The fractures in RIN group united on 14.9±1.1 weeks on average(range,12-16 weeks)after the operation with three cases having complications,including one cases of main nail breakage,one case of coxa vara and one case of superficial infection.The fractures in PFNA group united on 14.2±1.5 weeks on average(range,12-17 weeks)after the operation with three cases having complications,including one cases with locking screw backward,one case of coxa vara and one case of superficial infection.The union time among the three groups are statistically different with PFNA group having the shortest union time and PFLP having the shortest one.The complication rate among the three groups has no significant difference(P>0.05).The three groups has no significant different on the follow-up time.The Harris scores of PFLP group,RIN group and PFNA group were 80.56±6.66,87.94±3.57 and 91.06±4.3,respectively,with significant difference among three groups(all P<0.05).Patients in PFNA group has the best functional recovery(P<0.01).Conclusions: The intertrochanteric-subtrochanteric fractures of the femur of elderly patients can be treated using different internal fixation.Compared with PELP and RIN,PFNA can be completed with a shorter incision and operation time,less blood loss,shortened bone union time as well as better functional recoveries of the affected lower extremity. |
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