DHS、PFN And Total Hip Replacement Treatment Of Elderly Unstable Intertrochanteric Fracures Observed

Objective: To analyze the clinical treatment information and treatment outcomes ofsurgery within a fixed (DHS dynamic hip screw or PFN proximal femoral nail) with theuse of artificial joint replacement in the treatment of intertrochanteric fractures to study thetreatment of the two treatments intertrochanteric fracture of the advantages anddisadvantages, the choice of surgical methods for the clinical treatment of intertrochantericfracture basis.Methods: The diagnosis of Orthopaedics, Affiliated Hospital of ShandongUniversity of Traditional Chinese Medicine from March2009to September2011wereadmitted for94elderly patients with intertrochanteric fractures,48cases DHS or PFNfixation for the treatment of46the clinical efficacy of routine artificial hip replacement,internal fixation group and joint replacement group conducted a retrospective comparativestudy.Results: The average days of hospitalization in both groups, the mean preoperativehospital days, the incision length difference by t test, P>0.05, not statistically significantThe mean operative time by t test, P <0.05, significantly between the two groups,intraoperative blood loss, blood transfusion, postoperative drainage due to data notnormally distributed, the row rank sum test, P>0.05, not statistically significant. The twoget out of bed time: generally three days after the hip replacement group began to practicesitting at the bedside, take the initiative to exercise the knee, ankle and foot activity, thefirst five days of practice nurses assisted in the contralateral limb standing limb part of thediscreet, and gradual transition to a limb is completely discreet, walker about a week topractice walking. After the internal fixation group, as the case may wear anti-spin shoes tokeep the limb in neutral position of outreach to practice active motion of the hip, knee and ankle-foot bed. After surgery on a regular basis to review the X-rays to determine the fieldsbased on fracture healing, generally five to seven weeks after surgery can be graduallyweight bearing walking. The two groups have significant differences (P <0.01).Postoperative complications in94patients for15months follow-up, during the internalfixation group, postoperative complications:3cases (1) hip varus,(2) lower limb deepvenous thrombosis in four cases,(3) lung infection in4cases (4) femoral cutting twocases,(5) bedsores two cases,(6) two cases of stress ulcer, nonunion one cases (7),(8)postoperative recurrence fracture in1; artificial joint replacement:(1) lung infection in1case,(2) one cases of stress ulcer,(3) one cases of deep venous thrombosis,(4) at thefracture cases. Complication rate by t test, P <0.05, and its statistical significance, theinternal fixation group, the incidence of complications than replacement group, and thecomplications of internal fixation group and stay in bed. The two groups after six months,a year when the limb hip joint function recovery rating Harris score standards, according toexcellent (90to100points), good (80to89points), medium (70to79minutes) difference(<70points) four levels, to compare the different periods of limb hip joint function,excellent rate. Excellent rate of postoperative six months limb hip joint function by t test,significant differences (P <0.05). Excellent rate of the two groups after one year of hipjoint function was no significant difference (P>0.05), the replacement group to restore thelimb hip function faster.Conclusions: The present study, we consider that the use of DHS or PFN fixed andartificial joint replacement, treatment of intertrochanteric fractures can be achieved moresatisfactory results. Senior citizens (75years), short life expectancy, complications,complex fracture reduction difficult. We need an early resumption of the patients choice ofbed joint replacement therapy, and better than internal fixation. Therefore, the clinicalchoice of surgical approach to be comprehensive consideration.