| BackgroundWith the progress of the aging society in China,the incidence of hip fracture is gradually increasing and that doubles every 10 years for the people with the age of 50 and older.The number of intertrochanteric fracture accounts for 40% to 50% of that of hip fracture and almost all intertrochanteric fracture are caused by minor fall.After fracturing,elderly patients,with poor physical condition combined with basic diseases such as hypertension,diabetes and long-term bed treatment are prone to have lower extremity,deep vein thrombosis,hypostatic pneumonia,bedsore and many other complications.It not only affects the patient's recovery,but also leads to a significant lower quality of life and even death.So within 1 year the mortality rate of elderly patients after fracturing can reach 30%.Therefore,it is great challenge for modern orthopedic surgeons to improve the level of treatment and management of intertrochanteric fracture,make patients recover as soon as possible and minimize the mortality and disability rate of intertrochanteric fracture patients.At present,there is a general consensus among scholars at home and abroad on early surgical treatment for elderly patients with intertrochanteric fracture who can tolerate surgical treatment.The main surgical methods include femoral head replacement and PFNA internal fixation.In this study,elderly patients with unstable femoral intertrochanteric fracture who underwent artificial femoral head replacement and internal fixation with PFNA are selected as research objects,and their postoperative recovery status was followed up to provide ideas for the clinical treatment of elderly patients with unstable intertrochanteric fracture.ObjectiveThe choice of treatment methods for elderly patients with unstable intertrochanteric fractures has been controversial.The purpose of this paper is to compare the postoperative efficacy of artificial femoral head replacement and PFNA internal fixation in the treatment of elderly patients with unstable intertrochanteric fracture,to provide theoretical reference.Materials and methodsFrom January 2012 to December 2017,a retrospective study was conducted on 194 elderly patients with unstable intertrochanteric fractures treated with artificial femoral head replacement and PFNA internal fixation.There were 57 male patients and 137 female patients,with an average age of 79.53 years(ranging from 75 to 97 years).According to different surgical methods,the patients were divided into the artificial femoral head replacement group(joint replacement group)and the PFNA internal fixation group(internal fixation group).The weight training time,length of stay and the Harris and VAS scores at 3,6,12,and 24 months after surgery,and the incidence of postoperative complications,especially postoperative reoperation were compared.ResultsAll patients were followed up to 24 months after surgery.The incidence of postoperative complications in the joint replacement group was 4.85%,which was significantly lower than that in the internal fixation group(13.19%)and the difference was statistically significant(p<0.05).In particular,the incidence of postoperative reoperation was significantly lower than that in the internal fixation group;Weight training time in the joint replacement group and the internal fixation group were(2.08±0.69)and(27.96±2.72)days(p<0.05);The length of stay was 14.35±1.56 days and 13.93±1.69 days(p>0.05);The operative time was(56.12±6.24)minutes and(54.48±5.32)minutes(p>0.05);intraoperative blood loss was(242.81±26.30)ml and(231.83±28.60)ml(p>0.05);The Harris score in the joint replacement group and the internal fixation group were(63.52±5.90)and(58.09±4.60)point(p<0.05)at 3 months,The Harris score in the joint replacement group and the internal fixation group were(74.99±4.34)and(67.98±3.64)point(p<0.05)at 6 months,The Harris score in the joint replacement group and the internal fixation group were(81.04±5.06)and(82.02±4.41)point(p>0.05)at 12 months,The Harris score in the joint replacement group and the internal fixation group were(84.00±4.70)and(85.37±3.87)point(p>0.05)at 24 months;The VAS score in the joint replacement group and the internal fixation group were(2.18±0.91)and(3.35±0.90)point(p<0.05)at 3 months,The VAS score in the joint replacement group and the internal fixation group were(1.82±0.68)and(2.02±0.93)point(p>0.05)at 6 months,The VAS score in the joint replacement group and the internal fixation group were(1.68±0.60)and(1.87±1.01)point(p>0.05)at 12 months,The VAS score in the joint replacement group and the internal fixation group were(1.56±0.64)and(1.49±0.63)point(p>0.05)at 24 months.ConclusionArtificial femoral head arthroplasty and PFNA internal fixation are both effective methods for the treatment of unstable intertrochanteric fractures in elderly patients.However,the results of long-term follow-up showed that artificial femoral head arthroplasty could significantly improve the quality of life of patients by functional exercise as soon as possible,speeding up the recovery of patients,reducing the pain of patients,reducing the occurrence of complications,and reducing the rate of reoperation. |
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