Clinical Comparative Study Of Arthroplasty And Internal Fixation For Treatment Of Hip Fracture In Middled-aged And Elderly

Objective: To compare the clinical efficacy of arthroplasty and different internal fixation on hip fractures.Methods: A retrospective analysis of 110 patients with hip fracture were treated in our hospital from January 2012 to January 2015. Among them, 50 cases of male, female 60 cases. Aged 50 to 90 years, the average age of 68.49 years. The main injury factors were traffic accident and falling. Femoral neck fracture patients were 58 cases,32 cases were females,and 26 males,by garden type: Ⅰtype in 6 cases, type Ⅱ 11 cases, type Ⅲ 23 cases, type Ⅳ 18 cases. Intertrochanteric fracture were 52 cases, of which 28 females, 24 males, according to Tronzo-Evans classification: Ⅰtype 8 cases, type Ⅱ 9 cases, type Ⅲ 15 cases, type Ⅳ 12 cases, type Ⅴ 8 cases. patients were divided into two groups, arthroplasty group were 56 cases and internal fixation group 54 cases according to the surgical methods. Arthroplasty group included total hip replacement(THR) 30 cases and Hemiarthroplasty(FHA)26 cases. Internal fixation group included extramedullary fixation 32 cases(dynamic hip screw-DHS17 cases, proximal femoral locking plate-PFLP15 cases) and proximal femoral nail-PFN22 cases.Data were collected for statistical analysis as following aspects: operative time, blood loss, postoperative ambulation time, postoperative complications and postoperative hip function.Results: The operative time, blood loss, postoperative ambulation time of THA group were statistically significant from other groups(p <0.05), length of hospitalized were significantly different from intramedullary fixation group or extramedullary fixation group, but, was not statistically significant from hemiarthroplasty group(p <0.05); The blood loss and the postoperative ambulation time of hemiarthroplasty group were significant different from intramedullary fixation group or extramedullary fixation group(p <0.05), but operation time was not statistically different;The postoperative ambulation time and blood loss of the extramedullary fixation group were significant different from intramedullary fixation group(p <0.05),but operative time and length of hospitalized was no significant difference. The complications of extramedullary fixation group were significantly different from the other three groups(p <0.05), the other three groups showed no significant difference each others. The hip score of total hip arthroplasty were significantly different from other three groups(p <0.05), the other three groups showed no significant difference each others.Conclusion: Arthroplasty can reduce complications,ensure a batter hip function in treatment hip fracture,which can be selectet as the first choose. Intramedullary fixation allow patients have an early ambulation reduce the risk of related complications occurred in patients bedridden compared to extramedullary fixation. Intramedullary fixation can be a priority choice for those can not treatment by arthroplasty.