| Background: Intertrochanteric fractures of the femur are one of the most common fractures in the elderly.For the treatment of intertrochanteric fractures,early surgical treatment is now generally advocated by orthopedic surgeons,mainly bipolar long-stalk artificial femoral head replacement and proximal femoral nail antirotation.Both of the two schemes can well ensure the patients’ out-of-bed activities and reduce the complications during the stay in bed.However,there is still a great controversy on the indications of the two schemes.Objective: To analyze the clinical differences between bipolar long-stalk artificial femoral head replacement and proximal femoral nail antirotation in the treatment of intertrochanteric fractures in elderly patients.Methods: Totally 200 patients aged older than 75 years old with Tronzo-Evans I-V femoral fractures were enrolled,and followed up for 12 months.Eleven cases lost to follow up.Totally 189 cases completed the follow-up of.Among them,there were 95 cases of bipolar long-stalk artificial femoral head replacement and 94 cases of proximal femoral nail antirotation.Perioperative parameters,such as operation time,intraoperative blood loss,postoperative time of getting out of bed(beginning load bearing,complete load bearing),preoperative and postoperative coagulation function,complications during hospitalization and length of stay,were compared between the two groups.The postoperative hip function of the two groups was compared according to Harris functional score.Clinical and radiographic data were used to compare the complications within 12 months after surgery between the two groups.Results:(1)The operation time and postoperative weight-bearing time(starting to get out of bed after surgery,and the time to get out of bed completely after surgery)of the bipolar long-stalk artificial femoral head replacement group were lower than those of the proximal femoral nail antirotation group(P <0.05).(2)Harris scores at 1,2,3 and 6 months after operation were higher in the bipolar long-stalk artificial femoral head replacement group than in the proximal femoral nail antirotation group(P <0.05).Harris scores of the two groups were similar with no significant difference(P >0.05).(3)Regarding postoperative complications,the incidence of lower extremity venous thrombosis and pulmonary infection had significant difference between the two groups(P <0.05).Wound infection and secondary operation had no significant difference between the two groups(P >0.05).Overall incidence of complications was20% in the bipolar long-stalk artificial femoral head replacement group and 72% in the proximal femoral nail antirotation group;the difference between the two groups was statistically significant(P <0.05).Conclusion: It is concluded that for elderly patients with unstable intertrochanteric fractures,both bipolar long-stalk artificial femoral head replacement and proximal femoral nail antirotation internal fixation can achieve satisfactory results.However,the operation time of bipolar long-stalk artificial femoral head replacement is short,and early load bearing can be achieved,which is helpful to reduce long-term best-related complications,is in line with the idea of quick recovery,and can improve the quality of life of the patients. |
