| Purpose: The clinical efficacy of PFNA,Gamma nail and Inter Tan intramedullary fixation in the treatment of laternal wall dangerous intertrochanteric fracture of femur in the elderly was compared and analyzedMethods: Sixty elderly patients with lateral wall dangerous intertrochanteric fracture of femur(type 31-A2.2/2.3)were collected and analyzed in the Department of Orthopedics,Anqing Medical Center,Anhui Medical University from January 2019 to May 2021.There were 10 males and 10 females in the PFNA group.The average age was(67.75±5.14)years,ranging from 61 to 77 years.The time from injury to hospital admission was 1～3 days,with an average of(1.55±0.76)days;AO classification of fracture was31-A2.2 in 15 cases and 31-A2.3 in 5 cases.There were 12 males and 8 females in Gamma nail group.The average age was(68.60±4.90)years,ranging from 61 to 79 years.The time from injury to hospital admission was 1～3 days,with an average of(1.40±0.68)days.There were 11 cases of AO type 31-A2.2 and 9 cases of AO type31-A2.3.There were 11 males and 9 females in Inter Tan group.The average age was(67.65 ± 4.25)years,ranging from 62 to 75 years.The time from injury to hospital admission was 1～3 days,with an average of(1.40±0.68)days.There were 17 cases with AO type 31-A2.2 and 3 cases with AO type 31-A2.3.There were no significant differences among the three groups in gender,age,time from injury to hospital admission,fracture classification and other general information(p>0.05).Operation time,blood loss,number of fluoroscopy,PFS and TAD measurements at different postoperative periods,time of walking with weight and without crutches,and failure rate of internal fixation were recorded in each group.After the relevant data were collected and sorted out,SPSS 26.0 software statistical tool was used to analyze and compare the differences among the groups.Results: There was no significant difference in the number of perspective among the three groups(p>0.05).The differences in blood loss and operation time were statistically significant(P<0.05).The blood loss and operation time in PFNA group were lower than those in Gamma nail group and Inter Tan group(P<0.05).One week after surgery,there was no significant difference in the value of TAD among the three groups(P>0.05),and the difference began to appear at the 3rd and 12 th month after surgery(P<0.05).The Inter Tan group had lower TAD at the 3rd and 12 th month after surgery than the PFNA group and the Gamma nail group(P<0.05).At 1 week after surgery,there was no significant difference in the number of cases with PFS>5mm among the three groups(P>0.05).At the 3rd and 12 th month after surgery,there was a statistical difference in the number of cases with PFS>5mm(P<0.05).The number of patients with PFS>5mm in Inter Tan group was lower than that in PFNA group and Gamma nail group at 3 and12 months after surgery(P<0.05).The time of walking with weight and without crutches was statistically different among the three groups(P<0.05).The time of walking with weight and without crutches in Inter Tan group was smaller than that in PFNA group and Gamma nail group(P<0.05).There were no cases of failure of internal fixation such as infection,distal fracture of main nail and loosening of internal fixation in the three groups.Conclusion: The clinical efficacy of three kinds of intramedullary fixation in the treatment of laternal wall dangerous intertrochanteric fracture of femur in the elderly is satisfactory.PFNA has the advantages of short operation time and small amount of blood loss,and is suitable for older patients with poor tolerance to surgery.However,Inter Tan has little changes in TAD and PFS in the long-term follow-up stage,which can effectively reduce the shortening of the femoral neck,and is better than the other two methods of intramedullary fixation in terms of long-term stability,which is conducive to fracture healing and functional recovery of the affected limb.It is suitable for elderly patients with relatively young age and high requirements for functional recovery of the affected limb. |
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