A Comparative Study Of PFNA And InterTAN Intramedullary Nail In Elderly Unstable Intertrochanteric Femoral Fracture

ObjectiveThe purpose of this clinical study was to compare Proximal Femoral Nail Anti-rotation(PFNA)with proximal femoral nail InterTAN Hip Fracture Nailing System,The clinical effect analysis of InterTAN in the treatment of senile unstable Intertrochanteric Fracture(IFF)aims to provide reference and basis for the clinical treatment of senile unstable Femoral Fracture(IFF).MethodsA retrospective analysis was performed on 80 patients with senile unstable IFF treated with PFNA and InterTAN intramedullary nailsfrom the Department of Bone Surgery,the Second Affiliated Hospital of Shenyang Medical College from July 2017 to July 2022.According to Tronzo-Evans classification(Ⅲ-Ⅴ),38 patients were treated with PFNA internal fixation.InterTAN internal fixation was performed in 42 patients.Both groups were given the same treatment and functional exercises after surgery.In this study,general data of two groups were observed and recorded: gender(male/female),age(years),affected side(left/right),injury mechanism(fall injury/car crash injury/fall injury),complications(cardiovascular and cerebrovascular diseases and diabetes mellitus)and Tronzo-Evans classification(Ⅲ-Ⅴ).Surgical treatment:operation time(min),incision length(cm),early ambulation time(d),length of hospital stay(d),intraoperative blood loss(ml);Incidence of postoperative complications(%);Intraoperative blood transfusion(%);Visual Analogue Scale(VAS)scores before surgery and 1 week,1 month,2 months and 3 months after surgery;Harris hip score(Harris hip score)before surgery and at 1 week,1 month,3months and 6 months after surgery.Statistical software SPSS26.0 was used to analyze the related indicators collected by the two groups,and the clinical effects of the two groups in the treatment of patients with unstable IFF were compared.ResultsPatients in both groups were followed up for 6-9 months through outpatient visits,telephone calls,and other different methods.There were no significant differences in gender(male/female),age(years),affected side(left/right),injury mechanism(fall injury/car crash injury/fall injury),complications(cardiovascular and cerebrovascular diseases and diabetes mellitus)and Tronzo-Evans classification(Ⅲ-Ⅴ)between PFNA group and InterTAN group(P>0.05).PFNA group had the advantages of shorter operation time and less blood loss compared with InterTAN group,and the two groups had statistical significance(P<0.05).The InterTAN group was better than PFNA group in the early postoperative weight-bearing,and there was a statistically significant difference between the two groups(P<0.05).There was no significant difference in the length of hospitalization between the two groups(P>0.05).There was no significant difference in intraoperative blood transfusion between the two groups(P>0.05).In terms of pain degree,there was a gradual difference between the two groups with the extension of time,and the PFNA group had a higher pain degree score than the InterTAN group,which was statistically significant between the two groups(P<0.05).With the extension of postoperative follow-up time,the InterTAN group had a higher hip function score than the PFNA group,and the Harris score of the InterTAN group was better than that of the PFNA group at 1 week and 1 month after the surgery,and the difference was statistically significant(P<0.05).There was no significant difference in Harris scores between the two groups before surgery,3months after surgery and 6 months after surgery(P>0.05).There were no significant differences in the types of postoperative complications and the incidence of all postoperative complications between the two groups(P>0.05).ConclusionsIntraoperative comparison between the two groups showed that PFNA group had less blood loss and shorter operation time,and PFNA group was superior to InterTAN group.InterTAN group was superior to PFNA group in early postoperative weight bearing.In terms of pain degree,the two groups gradually showed a difference with the extension of time,and the PFNA group had a higher visual pain score than the InterTAN group,InterTAN group was better than the PFNA group.In terms of hip scores,InterTAN group had higher hip scores 1 week and 1 month after surgery,and InterTAN group was better than PFNA group.PFNA is recommended for patients with poor physical conditions,short operation time tolerance and many internal diseases.For patients with good physical conditions,who need stable and firm,early weight-bearing exercises to relieve physical pain,InterTAN treatment is selected.The two groups of surgical methods have their own advantages and disadvantages for senile unstable IFF,which provides reference and basis for clinical selection of appropriate surgical methods.