Evaluation On Curative Effect Of Three Operative Methods In Treatment Of Senile Intertrochanteric Fracture

【Objective】To compare the curative effect of fixation and femoral head replacement in treatment of senile intertrochanteric fracture.【Methods】A retrospective analysis in 69 elderly patients with intertrochanteric fractures treated in our hospital orthopedic from August 2004 to October 2008. 27 cases of artificial bipolar femoral head replacement therapy (ABFH replacement group): 15 males and 12 females; aged (77.11±5.59) years. The injury was by tumbling in 18 cases, falling from height in 4 cases, by accident traffic in 5 cases. Evans classification [1]:Ⅰ(6 cases),Ⅱ(9 cases),Ⅲ(9 cases),Ⅳ(3 cases). 19 patients with dynamic hip screw fixation (DHS fixation group): 8 males and 11 females; aged (73.47±7.23) years. The injury was by tumbling in 10 cases, falling from height in 3 cases, 5 cases of traffic accidents, other injuries in 1 case. Evans type:Ⅰ(7 cases),Ⅱ(6 cases),Ⅲ(5 cases),Ⅳ(1 case). 23 cases with anatomical plate therapy (anatomical plate fixation group): 10 males and 13 females; aged (75.04±6.93) years. The injury was by tumbling in 14 cases, falling from height in 3 cases, 6 cases of traffic accidents. Evans type:Ⅰ(6 cases),Ⅱ(8 cases),Ⅲ(7 cases),Ⅳ(2 cases).There were no significant differences in general data between three groups (P> 0.05). 3 groups of patients on hospitalization time, operative time, blood loss, out-of-bed time, postoperative Harris score and complications were analyzed.【Results】In 3 groups all incisions healed by first intention. ABFH replacement group 1 case of liver and renal failure occurred on the postoperative second day, 1 case of stress ulcer, 2 cases of double-limb length. DHS fixation group, pulmonary infection occurred in 1 case on the postoperative fourth day, 1 case of urinary tract infection, 2 cases of coxa adducta, 1 case of implant failure, 1 case of double-limb length. Anatomical plate group 2 patients had urinary tract infection, 3 cases of deep venous thrombosis, 1 case of fixation failure, coxa adducta and double-limb length.occurred in 4 cases. ABFH replacement group compared with fixation groups, there was significant difference in out-of-bed time (P <0.05);the differences in operative time, blood loss and hospitalization time was not statistically significant (P> 0.05) ; There were significant differences in Harris score after operation 1 year between ABFH replacement group and fixation groups(P <0.05).【Conclusion】Each surgical treatment has its own advantages, DHS is suitable for better conditions in the bone, stable EvansⅠ,Ⅱtype of intertrochanteric fracture; anatomical plate is applicable to EvansⅠ~Ⅳtype of intertrochanteric fracture and Reverse intertrochanteric fracture, especially to senile fractures which inner structure is unstable or the trochanter major is crushed, but it results in longer stay-in-bed time and more complications; ABFH replacement treatment is suitable for EvansⅢ,Ⅳelderly ones with osteoporosis, serious intertrochanteric fracture who has a high quality of life and good health condition before injury. It has obvious advantages over internal fixation, such as early ambulation, less time in bed. It helps to improve the curative effect and avoid fixation failure, coxa adducta or other complications, so that patients can quickly return to or near pre-injury standard of living, improve the patients'quality of life.