The Clinical Study Of Comminuted Intertrochanteric Fracture Treatment Of PFNA In The Elderly

Objective： To investigate the clinical efficacy of the elderly comminutedintertrochanteric fractures treatment of PFNA.Methods：Date of85patients,comminuted Intertrochanteric Fracture treatment ofPFNA,were closed fractures, at the Orthopedic Department Ⅰof The First AffiliatedHospital of Fujian Medical University (triple A hospital),from January2010toJanuary2014,were retrospectively analyzed, including35males and50females;agedfrom65to90years,an average of79.31±6.21years;41cases of the left side,44casesof the right side;according to AO classification: A2.115cases; A2.228cases; A2.334cases; A3.38cases.Recording and analysis of all patients with closed reductiontime,incision length,operative blood loss,postoperative drainage,postoperativeweight-bearing time,clinical healing time of fracture,treatment of lower extremitydeep venous thrombosis before operation and postoperative complications.Accordingto the Harris hip function score standard(Appendix1), to evaluate the postoperativefunction of hips,problems encountered in the application of PFNA,were discussed andanalysis.Results：Closed reduction time: A2.111~36min, an average of19.67±7.83min; A2.218~47min,an average of29.67±7.99min;A2.319~60min,an average of37.17±10.01min;A3.329~62min,an average of45.88±9.75min,closed reduction timein the4groups had significant difference.Incision length was3~10cm, an average of5.11±1.76cm.Operative blood loss was50~300ml,an average of110.94±63.69ml.Postoperative drainage was120-320ml,an average of165.63±52.35ml.Postoperative weight-bearing time was9~32d,an average of12.47±3.90d.Incision length,operative blood loss,postoperative drainage,postoperativeweight-bearing time in the4groups had not significant difference.85patients werefollowed up for3~36months,an average of13months:all fractures healed,thehealing time of9~24w,the average clinical healing time of fracture was12.56±3.63w;does not appear varus,internal fixation failure and cutting phenomenon;aftertreatment of deep venous thrombosis patients before the operation,postoperativeobservation and no recurrent thrombosis and lead to pulmonary embolism.According to the Harris hip function score standard(Appendix1),excellent in73cases,good in7cases,general in5cases,poor in0cases,the excellent and good rate was94.1%.Conclusion：1,in the treatment of intertrochanteric fractures,the greater the degree ofcomminution instability,the longer closed reduction time;2,there are a lot of hiddenbiood loss in the perioperative period,should be prevent and promptly correct toreduce complications;Closed reduction and minimally invasive with PFNA is suitablefor A2,A3type of intertrochanteric fracture of the elderly.