Comparison Of Joint Replacement And Internal Fixation In The Treatment Of Unstable Intertrochanteric Femoral Fractures In Advanced Age

Objective(s):To analyze and compare the clinical efficacy of two surgical procedures,hip arthroplasty and internal fixation,in the treatment of unstable intertrochanteric fractures in advanced age,and to provide guidance for the choice of clinical treatment.Methods:A retrospective analysis was performed on 120 patients included in the study.Patients were grouped and numbered according to the selected surgical procedure as replacement group or internal fixation group,and the preoperative,perioperative,follow-up and imaging data of both groups were recorded for analysis so as to compare the clinical efficacy of both procedures.Results:1.General data:There was no statistically significant difference in the comparison of all preoperative data between the two groups(P>0.05).2.Perioperative results:The internal fixation group was superior to the replacement group in terms of operative time,incision length,intraoperative bleeding,and postoperative drainage,all with statistically significant differences(P<0.05).The replacement group was superior to the internal fixation group in terms of intraoperative fluoroscopy time and hospital stay,and the difference was statistically significant(P<0.05).3.Follow-up results:The 120 patients in this study were followed up for a period of(12-36)months after surgery,with a mean of(20.01±6.76)months.The time to walk on the ground and the time to full weight-bearing activity were earlier in the replacement group than in the internal fixation group,and the differences were statistically significant(P<0.05).The VAS scores of patients in both groups within each group decreased significantly with the time point of follow-up,with a statistically significant difference(P<0.05).At 1 month postoperatively,the VAS scores in the fixation group were smaller than those in the replacement group,with a statistically significant difference(P<0.05).At 6 months postoperatively and at the final follow-up,there was no statistically significant difference in VAS scores between the two groups(P>0.05).Over time,the Harris score of hip function increased significantly between the different follow-up time points within each group in both groups at postoperative follow-up,with a statistically significant difference(P<0.05).At 1 and 6 months postoperatively,the Harris scores of patients in the replacement group were significantly greater than those in the fixed group,with a statistically significant difference between the two groups(P<0.05).At the final follow-up,there was no statistically significant difference in Harris score between the two groups(P>0.05).Postoperative radiographs showed that all 60 patients in the fixed group achieved good fracture repositioning and satisfactory and stable internal fixation in the immediate postoperative period.In the replacement group,all 60 patients achieved immediate biocompression of the femoral prosthesis stem,and 12 of the patients with total hip replacement achieved good biocompression of the acetabular cup;6 months after surgery,the femoral prosthesis stem was well fixed,and all patients had stable bone growth;at the last follow-up,all 60 patients did not have any loosening or dislocation of the prosthesis.Conclusion(s):According to the results,both PFNA internal fixation and artificial hip replacement can be used for the treatment of unstable intertrochanteric fractures in advanced age and can achieve satisfactory clinical results.The advantages of PFNA internal fixation include shorter operation time,less intraoperative bleeding,less trauma to the patient and less postoperative drainage.Compared with PFNA,hip arthroplasty has less fluoroscopy,shorter hospital stay,faster pain relief,faster recovery of hip function,earlier weight-bearing,and can achieve early activity,which has good clinical efficacy in the treatment of high-grade intertrochanteric fracture and can improve patients’ postoperative quality of life.Therefore,artificial hip arthroplasty may be a better choice for patients with unstable intertrochanteric femoral fractures of advanced age with a high risk of internal fixation failure,such as those with severe osteoporosis,comminuted fractures,and fragile or damaged lateral walls.Clinical selection of treatment modality should strictly grasp the indications,choose the appropriate surgical method and develop a scientific treatment plan,thus reducing patient pain and achieving rapid recovery.