Comparative Efficacy Of Hip Arthroplasty And Internal Fixation For The Treatment Of Unstable Intertrochanteric Fractures In Elderly Patients

Objective:To compare the operation time, blood loss, postoperative time in bed, the incidence of postoperative complications and postoperative Harris hip score reduction between Hip Arthroplasty and Internal Fixation for Unstable Intertrochanteric Fractures in Elderly Patients. Investigate the clinical efficacy and indications of the two methods.Materials and Methods:70 old patients suffered from intertrochanteric fractures were selected from January 2007 to November 2009 in the Affiliated Yuebei peoples Hospital of the medical college of Shantou University, The ages were between 60 to 101 and the average age was 76.2. there were 41 examples with age above 75 year old. All the 70 cases were unstable fracture, above Evans-Jensen type-III, The osteoporosis Singh index of the contralateral neck of femur were in the three following. 53 cases were in the Fixation group, including 39 cases fixed by DHS, DCS fixed 3 cases, hollow screw fixed 2 cases, anatomical plate fixed 9 cases . The average age was 75, and there were 27 cases above 75 year old.25 patients were with other chronic medical disease. the fllow-up time for this group was between 1 months to 40 months, and the average flow-up time was 19.3 months. The hip arthroplasty group included 17 patients,the average age was 79.8 . there were 14 patients with age above 75 year old. All 17 patients were with other chronic medical disease. The fllow-up time for this group was between 1 months to 35 months, and the average flow-up time was 14.2 months. compare the operation time, blood loss, postoperative time in bed, the incidence of postoperative complications and postoperative harris hip score reduction between These two groups. The data was processed by statistical software SPSS 17.0. Results:There was no difference in operation time between the hip arthroplasty group and the internal fixation group (T-test, P> 0.05). There was difference of bleeding volume between the two groups (T test, P <0.05), The bleeding of hip arthroplasty group was more than the internal fixed Group. There was no statistical difference between the two groups in the incidence of postoperative complications (x 2 test, P> 0.05). two groups were significantly different in postoperative time in bed (T test, P <0.05). Hip arthroplasty group was short than the internal fixed Group; There was significant difference between the two groups in postoperative Harris hip score decreased (T test, P <0.05), The clinical effects of the hip arthroplasty was better than that of the internal fixation group. There was statistical difference in incidence of postoperative complications and Harris score between the Internal fixation and arthroplasty above 75 years (P <0.05 ). There was significant difference (P <0.05) in incidence of postoperative complications and Harris score whose singh index below 2 level between the Internal fixation and arthroplasty. That above 75 years or singh index below 2 level had lower incidence of complications and better joint function in using hip arthroplasty.Conclusion:1:To treat the Unstable Intertrochanteric Fractures in Elderly Patients using Hip Arthroplasty and Internal fixation, Hip Arthroplasty had short time on bed and better joint function ,but more blood loss .The operation time and incidence of complications had no significant differences.In the age above 75 years or singh index below 2 level,Hip Arthroplasty had less incidence of complications and better joint function than internal fixation.2: Selection of surgical method for Unstable intertrochanteric fractures of elderly patients should be based on fracture type and specific conditions. Internal fixation should be the preferred fashion for the Unstable Intertrochanteric Fractures in Elderly Patients who had no serious complications and could tolerate long-term bed rest. Hip Arthroplasty was a reasonable choice for the Unstable Intertrochanteric Fractures in Elderly Patients who in the age above 75 years or singh index below 2 level, internal fixation had unclear effecty, could not tolerate long-term bed rest and Pursued early ambulation.3:The treatment for coexisting medical disease was necessary, and The best timing of surgery should be within 48 hours after injury; The patients who used internal fixation should pay attention to functional training in the bed, preventing the complications caused by the long-term bed; The patients who used Hip arthroplasty should emphasis early Walking Exercise , and promote the joint function.