| Background: Clinically,there are different methods that can be used to treat unstable intertrochanteric fractures.Among them,artificial replacement is becoming more and more widely used,and the effective fixation of the greater trochanter is a key point in this operation.The main fixation methods of greater trochanter are steel wire,aixibang suture,anatomical steel plate and so on.However,we find that there are few comparative studies on different fixation methods of greater trochanter,so this study compares two different fixation forms of greater trochanter,that is,wire fixation and anatomical plate fixation,through retrospective analysis,we discussed and analyzed the curative effect of these two fixation methods,so as to offer assistance in clinical practice.Materials and Methods: From September 2018 to June 2020,we collected the clinical data of patients with intertrochanteric fracture who underwent the first artificial femoral head replacement in our hospital(the second Hospital of Dalian Medical University).After the evaluation of the case-related data,according to the inclusion criteria and exclusion criteria,a total of 46 patients who met the criteria were included in this retrospective analysis.Depending on the different fixation methods of the greater trochanter,we divide patient data into two categories: steel wire fixation group(26 cases)and anatomical plate fixation group(20 cases).The data collected included general basic data of patients,operation-related records,pain and functional evaluation indicators.The general basic data of the patients were sex and age,the side of the affected limb(left and right),and the types of fracture,and the operation-related indicators were as follows: the duration of operation(min),the amount of intraoperative blood loss(ml),the length of incision(cm),24 h drainage(ml),the first time of weight-bearing in the ground(d),and the rate of complex complications(venous thrombosis,delayed wound healing,et al.).The evaluation indexes included VAS pain score at admission,1 week after operation,1month,3 and 6 months after operation,and excellent and good rate and Harris score of hip joint at corresponding time point.Using SPSS 26.0 software to processed the data in the course of this research.The measurement data,such as incision length,operation time,intraoperative blood loss using mean ±standard deviation((?)±s)to express.We using T-test to compare measurement date,and paired t-test was used for comparison between counting data.Counting data such as the sex of the patients were measured by the rectangular test,and P < 0.05 was taken as the data difference with significance.Results: The operation process of all cases was smooth,and postoperative data statistics and postoperative follow-up were carried out.The results showed that there was no significant difference in general data(age,sex,fracture classification)and operationrelated indexes(intraoperative blood loss,surgical incision length,24 h drainage after operation),P > 0.05.The operation time of steel wire fixation group was(102.08±4.59)min,and that of steel plate fixation group was(115.95 ±7.74)min,there is statistically significant(P=0.000<0.05).The first weight-bearing time of steel wire was(3.21 ±0.57)days,and that of steel plate fixation group was(2.73 ±0.60)d,P <0.05,statistically meaningful.In terms of VAS pain score,each group was significantly lower than that before surgery.However,after the operation,the steel plate group was significantly lower than the steel wire group at 1 week,1,3 months,P<0.05,Statistically meaningful.No difference found in the 6th month.The Harris scores of the steel wire fixation group were(45.58±2.30),(62.92 ±2.68),(71.00 ±2.04),and the steel plate fixation group were(47.25±2.36),(65.30 ±3.26),(73.35 ±3.88),at 1 week,the first and third months after surgery.The analysis shows that(1 week t=-2.418,P=0.020),(the first month,t=-2.719,P=0.009),(the third month,t=-2.458,P=0.021),P<0.05,statistically significant.No difference was found in Harris score and excellent and good rate at 6 months after operation.In terms of complications,one patient with intermuscular venous thrombosis was found in the affected limb in the steel wire fixation group,and the complication probability reaches to 3.85%.In the steel plate fixation group,there were 2cases of incision fat liquefaction that led to delayed wound healing,and the complication rate was up to 10%.3.85% VS 10%,X~2= 0.056,P=0814>0.05,the comparison shows no significance.Postoperative X-ray examination of the two groups showed that the prosthesis was in good position,No major complications were found in all postoperative cases during this study.Conclusion: It can be seen from the above,both steel wire and anatomical plate fixation of the greater trochanter combined with artificial femoral head replacement are feasible ways to treat unstable intertrochanteric fractures.It creates a biomechanically stable structure and rebuilds the outer wall to maintain sufficient lever arm and abduction strength.As a result,it realizes the advantage of more reliable fixation and easier for patients to carry weight in the early stage,significantly accelerates the rate of improvement of the affected limb,and contributes to the improvement of patient expectations and satisfaction.It is undeniable that the medical cost of the steel plate group is slightly higher than that of the steel wire group,so clinicians should comprehensively consider the situation of patients and recommend individualized treatment for patients.However,if measured in terms of patient treatment goals,that is,only considering the postoperative efficacy of patients and improving patient satisfaction and expectations,we may be more inclined to recommend the use of anatomical plates to fix the greater trochanter. |
PDF Full Text Request