| Objective:Objective to compare the intraoperative and postoperative clinical effects of femoral head replacement and PFNA(proximal femoral nail antirotation)internal fixation in the treatment of elderly patients with subtrochanteric fracture of femur,so as to provide relevant evidence for the clinical treatment of elderly patients with subtrochanteric fracture of femur and select the best surgical treatment.Methods:A total of 72 patients(72 hips)over 75 years old with subtrochanteric fracture of femur who were treated with femoral head replacement and PFNA internal fixation in the Department of orthopedics of our hospital from January 2013 to January 2018 were collected,which were conducted by retrospective study.If necessary,small incision at the fracture site was used to assist the reduction and wire cerclage fixation.There were 35 cases(35 hips)in the joint replacement group and37 cases(37 hips)in the PFNA internal fixation group,including 10 males and 25 females in the artificial femoral head replacement group,with an average age of(83.77 ± 4.45)years old,34 cases were injured due to falls and 1 case was injured in traffic accidents;there were 12 males and 25 females in the PFNA group,with an average age of(82.03 ± 4.19)years old,36 cases were injured due to falls and 1case was injured in traffic accidents;the fracture degree of the two groups was statistically significant According to seinsheimer classification.The operation time,intraoperative bleeding,incision length,postoperative landing time,weight-bearing time and hospitalization expenses of the two groups were compared.The VAS score and Harris hip function score of the two groups at 7 days,1 month,3 months,6months and 12 months after operation were compared,and the postoperative complications of the two groups were statistically analyzed.Based on the above data,the intraoperative,early postoperative and long-term clinical effects of the two groups were compared to provide evidence for clinical treatment.Results:All 72 patients were followed up for 12-17 months.There was no significant difference in age,gender,cause of injury and seinsheimer classification between femoral head replacement group and PFNA group(P > 0.05);the average operation time of femoral head replacement group was slightly shorter than that of PFNA group,but the difference was not statistically significant(P > 0.05);the intraoperative bleeding and incision length of PFNA group were less than that of femoral head replacement group(P <0.05),but the difference was not statistically significant(P > 0.05)The hospitalization cost of the femoral head replacement group was lower than that of the PFNA group(P < 0.05);and in terms of postoperative effect,the femoral head replacement group was able to carry out weight-bearing activities 2-5 days after the artificial femoral head replacement,and the PFNA group was able to carry out weight-bearing activities 4 weeks after the operation,and it took 12 weeks to carry out weight-bearing activities.Therefore,the average landing time and weight-bearing time of the femoral head replacement group were much shorter than those of the PFNA group(P < 0.05);In terms of Harris hip score,the score of 7 days,1 month and 3 months after operation in the artificial femoral head replacement group was significantly higher than that in the PFNA group(P < 0.05),but there was no significant difference in Harris hip score between the two groups at 6 months and 12 months after operation(P > 0.05);In terms of VAS score,the score of 7 days and 1 month after operation in the artificial femoral head replacement group was better than that in the PFNA group(P < 0.05),there was no significant difference between the two groups at 3months,6 months and 12 months(P > 0.05);In terms of postoperative complications,PFNA group had 4 cases of pneumonia,2 cases of deep vein thrombosis,2 cases of peripheral fracture of prosthesis,5 cases of delayed union,1 case of nonunion;Artificial femoral head replacement group had 1 case of peripheral fracture of prosthesis,1 case of superficial infection of incision,no case of deep vein thrombosis,pneumonia and nonunion of fracture..Comparing the clinical effects of the two groups,it was found that in the case of similar operation time,the intraoperative bleeding and incision length of PFNA group were better than that of the femoral head replacement group,but the artificial femoral head replacement showed its advantages in hospitalization cost,weight-bearing time,early postoperative pain,hip function and complications.Conclusion:1.For the elderly patients with subtrochanteric fracture,artificial femoral head replacement can reduce pain,obtain better hip function,allow weight-bearing activities,and significantly improve the early postoperative quality of life;2.Artificial femoral head replacement can reduce the incidence of bed rest related complications and fracture healing related complications in elderly patients with subtrochanteric fracture;3.Artificial femoral head replacement provides another choice for elderly patients with subtrochanteric fracture. |
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