Manipulative Reduction And Three-dimensional External Fixator In The Treatment Of Geriatric Patients With Intertrochanteric Fracture

Objective:The clinical efficacy of manipulative reduction combined with three-dimensional external fixation to treat the geriatric patients with intertrochanteric fracture,with the aim of further confirming the feasibility,effectiveness and safety of the therapy,thus providing evidence-based medical evidence for its popularization and application in clinical practice.Methods:The study of 60 elderly intertrochanteric fractures who met the criteria from February 2019 to September 2019 was randomly divided into two groups,the control group(PFNA group,n=30): closed reduction with the PFNA internal fixation therapy,the trial group(three-dimensional external fixator group,n=30): The method was used to three-dimensional external treatment.General preoperative data on two groups of patients,including the patient’s sex,age,fracture type,fracture site,and the American Anesthesiology Association’s preoperative ASA rating were statistically unable to differ significantly(P>0.05).The operating time,postoperative blood transfusion rate,hospital time and hospitalization cost were recorded in two groups.To observe the degree of thigh swelling of the preoperative and the 1st,2nd,3th and 5th days after surgery.To observe the VAS scores of the first,second,third and five days after surgery,and to observe the incidence of fracture complications in both groups,Fracture complications include: fracture site infection,internal fixation cutting,internal fixation fracture,fracture secondary displacement,re-surgery.X-rays assessed fracture healing in the first,second,third and sixth months after surgery in both groups of patients.Clinical evaluation of hip function(Harris score)in the 3rd and 6th months after surgery.Clinical evaluation of mortality in the 6th months after surgery.The two sets of data are analyzed and concluded.Results:1.General information: 60 patients with an average age of 78.6 years,22 cases of men and 38 cases of women.The preoperative sex,age,fracture AO type,fracture site,ASA anesthesia rating was statistically tested without significant difference(P>0.05).2.Surgery and hospitalization: The mean operating time in the control group(PFNA)and the trial group(EF group)was 58.33 minutes and 36.03 minutes(P<0.05),respectively.Blood transfusion was needed 14 cases in the control group,and 1 case blood transfusion was needed after the test group(P<0.05).The average length of hospitalization in the control group was 15.36 days,the mean hospitalization cost was 37,136 yuan,the average hospital stay in the experimental group was 11.4 days,and the mean hospitalization cost was 15732 yuan.The EF group had significantly less than the control group in terms of operating time,postoperative blood transfusion rate,hospitalization time and hospitalization cost,and there was a significant difference between the two groups of statistical tests(P < 0.05).Postoperative swelling and pain were obviously in the control group(P<0.05),and there were significant differences in the two groups of statistical tests.3.Complications: 1 case of PFNA screw blade cut,1 case of spiral blade loose,no cases of internal fixation breakage were found in both groups,and no significant difference in the two groups of fracture complications(P>0.05).A total of 5 deaths were reported in the 6 months after surgery,of which 3 were in the control group and 2 in the experimental group,with no significant difference in mortality in the two groups(P>0.05).4.Infection: No cases of deep infection were found in both groups following up after surgery.The test group 5 patients with serous discharge of pin site,strengthen the pin care combined with oral antibiotic treatment,control group after follow-up did not find infected cases.5.HHS and fracture healing: 3 months after surgery,the average hip Harris score was 57.55 and 56.23 points in trial group and the control group,respectively.and 67.00 and 66.80 points 6 months after surgery,there was no significant difference in statistics between the two groups;2 months after surgery,Fracture healing in the test group and control group was respectively 4 and 3 cases respectively,21 cases and 19 cases in 3 months after surgery,follow-up found that 1 case of PFNA spiral blade cutting in the control group caused the fracture not to heal,the remaining cases were completely healed in 6 months after surgery,and there was no statistical difference between the two groups of fracture union rates(P>0.05).Conclusion:Two surgical methods to treat the fractures between the elderly femurs were able to obtain good results,and there was no significant difference between the two groups of complications.The advantage of three-dimensional external fixator is simple installation,short operation time,no blood transfusion after surgery,slight swelling and pain after surgery,less hospital time and cost,satisfactory functional results,for patients who can not tolerate internal fixed surgery and high-risk anesthesia risk of A1 type and A2 type elderly patients,can try to apply the three-dimensional external fixator.