| Objective Intertrochanteric fracture of the femur is a common type of fracture in the elderly.Although the renewal and advancement of surgical techniques and internal fixation devices have significantly improved the prognosis of patients with hip fractures,a certain proportion of patients still have re-fractures of the contralateral hip after surgery.This group of studies compared the hip joint function and the bone density change trend of contralateral hip of artificial femoral head replacement and proximal femoral nail anti-rotation(PFNA)for the treatment of elderly intertrochanteric fractures.The risk of re-fracture of the lateral hip is to improve the understanding of the re-fracture of the contralateral hip after hip fracture,to provide a reference for the selection of clinical surgery and the management of osteoporosis in patients after the disease,so as to reduce the harm of re-fracture.Method 71 patients with comminuted femoral intertrochanteric fractures over 75 years old who were admitted to our hospital from September 2017 to August 2018 were selected for retrospective analysis,and were divided into PFNA group and artificial femoral head replacement group according to different surgical methods.The Harris function score of the hip joint and the bone mineral density of the contralateral hip were compared between the two groups of patients 1,3,6,and 12 months after surgery.X-rays were taken to evaluate the implantation of the prosthesis.Compare the two groups of patients:(1)Perioperative data: operation time,incision length(PFNA is the main nail incision length),intraoperative blood loss,postoperative weight-bearing time,hospital stay,hospitalization expenses;(2)postoperative Harris score(postoperative 1 month,3 months,6 months,12 months),record the bone mineral density of the contralateral hip in different periods(immediately after operation,1month,3 months,6 months,12 months after operation)),analyze the changes in the bone mineral density of the contralateral hip.(3)Postoperative complications occurred.(4)Re-fracture of the contralateral hip.Results All patients were followed up to 12 months after surgery.The length of the surgical incision in the PFNA group and the artificial femoral head replacement group was 5.70±1.72 cm and 11.16±2.07 cm,respectively(p<0.05);the operation time was66.73±19.91 and 91.13±29.40 minutes in the PFNA group and the artificial femoral head replacement group,respectively(p <0.05);intraoperative blood loss was104.67±74.14 and 148.48±89.67 ml in the PFNA group and artificial femoral head replacement group,respectively(p<0.05);the average hospital stay was 9.28±2.59 and 12.35 in the PFNA group and artificial femoral head replacement group,respectively ±4.02 days(p<0.05);hospitalization expenditures were22030.54±3627.97 and 29270.26±3210.77 yuan in the PFNA group and artificial femoral head replacement group(p<0.05);the postoperative weight-bearing time of the PFNA group and artificial femoral head replacement group were respectively44.98±6.51 and 5.91±4.22 days(p<0.05).The Harris scores in the PFNA group and artificial femoral head replacement group were 29.92±3.55 and 50.67±8.97 in the first month after surgery(p<0.05);the Harris scores in the PFNA group and artificial femoral head replacement group were 46.84 in the third month after surgery.±4.54 and 69.04±10.05(p<0.05);Harris scores in the PFNA group and artificial femoral head replacement group at the 6th month after surgery were 71.34±8.89 and74.39±8.10(p>0.05);PFNA at the 12 th month after surgery The Harris scores of the artificial femoral head replacement group and the artificial femoral head replacement group were 78.48±9.17 and 78.70±7.78,respectively(p>0.05).Immediately after operation-the first month after the operation,the changes in the contralateral hip bone mineral density in the PFNA group and the artificial femoral head replacement group were-0.06±0.06 and-0.02±0.01(p<0.05);the first month after the operation-the third The changes in bone mineral density of the contralateral hip in the PFNA group and artificial femoral head replacement group were-0.03±0.03 and-0.02±0.02(p<0.05);the bone mineral density of the contralateral hip in the 3rd-6th month after operation The changes were-0.02±0.05 and 0.02±0.02(p<0.05);the changes in the bone mineral density of the contralateral hip were 0.09±0.08 and 0.16±0.07 in the 6-12 months postoperatively.The results of repeated ANOVA showed that the differences of the time of bone mineral density in contralateral hip change and interactions of surgical modalities between two groups were statistically significant after operation(P< 0.01).Comparing two groups at the same time,the changes in the density of the opposite hip bone after surgery in the PFNA group were lower than those in the FHR group(P<0.05～P<0.01).The postoperative complication rate was 15.4% and 5.3% in the PFNA group and artificial femoral head replacement group,respectively(p<0.05).The incidence of re-fracture of the contralateral hip after operation was 3.80% and 0%in the PFNA group and the artificial femoral head replacement group(p>0.05).Conclusion Both types of surgery need to strengthen anti-osteoporosis treatment and safety protection for at least one year.Artificial femoral head replacement significantly reduces the time spent in bed after surgery,helps early functional exercise,and restores the bone density of the contralateral hip earlier and faster after surgery,which helps reduce the risk of contralateral hip fracture. |
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