Study On The Relationship Between Femoral Collodiaphyseal Angle And Intertrochanteric Fracture Classification And Guiding The InterTAN Operation

Objective:To study the relationship between the healthy side femoral collodiaphyseal angle and the classification of intertrochanteric fractures of the affected side,and guiding the Inter TAN fixation of intertrochanteric fraction by measuring the healthy side femoral colloidaphyseal angle.Methods:A retrospective analysis was performed on 66 patients who received InterTAN intramedullarynailing for intertrochanteric fractures of femur from January 2014 to January 2018,which were unilateral intertrochanteric fractures.The study group included 33 cases in which guiding the InterTAN fixation of intertrochanteric fraction by measuring the healthy side femoral collodiaphyseal angle.the control group included 33 cases in which guiding the above opration by the traditional visual method.The preoperative diagnosis of unilateral intertrochanteric femoral fracture was confirmed by the antero-posterior DR of the both hip joints,then the define classification by the CT and the three-dimensional bone reconstruction.The oprators measured the the healthy side femoral collodiaphyseal angle in DR before the opration,then adjust the angle of the affected side and performed interTAN fixation according to it in the study group.In the control group,the angle of the healthy side collodiaphyseal angle was not measured preoperatively,the operators performed the opration by the traditional visual method during the intraoperative fluoroscopy.Preoperative and postoperative radiographs were taken in the two groups,and preoperative healthy side cervical Angle and postoperative bilateral femoral cervical Angle were measured.Compararing the operative time,estimated amount of blood loss,postoperative Harris score and patient satisfaction survey between the two groups was performed by statistical analysis.The difference was statistically significant by P<0.05.Result:1.66 cases of intertrochanteric fracture of femoral neck were classified as type A1 in 16 cases,the healthy side femoral collodiaphyseal angle 130.67 ± 2.40 degrees;type A2 in 44 cases,the healthy side femoral collodiaphyseal angle 131.38 ± 2.98 degrees;type A3 in 6 cases,the healthy side femoral collodiaphyseal angle 129.38 ± 3.33degrees.A few cases of type A3 can not be accurately analyzed.A comparative analysis of type A1 andtype A2 shows that there is no significant difference in the healthy side femoral collodiaphyseal angle between the two groups.2.The average operation time in the study group was 98.18± 18.65 min,and the estimated amount of bleeding during the operation was 101.51 ±31.83 ml.The average operation time in the control group was 197.24±68.40 minutes,and the estamated amount of bleeding during operation was about 198.48 ± 131.98 ml.There was a significant difference in opration time between the two methods(P<0.05),and there was a significant difference in the estimated amount of bleeding during operation(P<0.05).3.In the study group,the healthy side femoral collodiaphyseal angle was 131.94 ±3.44 degrees and the affected side femoral collodiaphyseal angle was 130.09 ± 4.41 degrees after surgical correction.There was no significant difference between the two groups(P>0.05).In the control group,the healthy side femoral collodiaphyseal angle was 130.36± 3.31 degrees,and that of the affected side was 130.48 ± 6.55 degrees after operation.There was no significant difference between the two groups(P>0.05).4.There was 1 case with complications occurred in the study group,which was pulmonary infection.There was 7 cases with complications occurred in the control group.x2=5.12,P<0.01.5.66 patients were followed up for 3 to 17 months with a follow-up rate of 100%.Quantitative analysis by Harris score showed that 90.58 ± 1.77 points in the study group and 100%satisfaction in the control group,on other hand,87.30±5.44 points and 87.88%satisfaction in the control group.Conclusion:1.There was no correlation between the anatomical spatial morphology of the healthy side femoral collodiaphyseal angle and the classification of intertrochanteric fractures of the affected side.2.Guiding the InterTAN fixation of femoral intertrochanteric fractures on the affected side by measuring the healthy side femoral collodiaphyseal angle is feasible,which can shorten the operation time,reduce blood loss and reduce surgical complications.