Clinical Effect Of PFNA And InterTAN In The Treatment Of Intertrochanteric Fractures In The Elderly

Objective: The purpose of this study was to analyze the clinical efficacy of two different intramedullary fixation methods of proximal femoral nail anti-rotation(PFNA)and intertrochanteric antegrade nail(InterTAN)in the treatment of intertrochanteric fractures in the elderly,to explore the guiding significance of the concept of “combining muscles and bones”in the whole treatment process,and to provide reference and basis for the future treatment of the disease with integrated traditional Chinese and western medicine.Methods: From October 2017 to January 2019,78 elderly patients who underwent surgical treatment in the Department of Orthopaedics of Affiliated Hospital of Shandong University of Traditional Chinese Medicine were divided into two groups:PFNA group(n=40)and InterTAN group(n=38).The intraoperative operation time,intraoperative bleeding volume,surgical incision length,fracture clinical healing time and postoperative complications(local complications:hip varus deformity,fracture slow healing,fracture nonunion,incision infection,postoperative refracture,loosening or breaking of the built-in material,etc.;systemic complications: bedsore,deep venous thrombosis,pulmonary infection,urinary tract infection,pulmonary embolism,etc.)were recorded in the two groups.Recording hip function Harris score at outpatient follow-up at 1,3,6,12 months after operation,recording Chinese medicine syndrome curative effect evaluation at the last follow-up,and performing statistical analysis of data using SPSS 20.0 statistics software.Results: 78 patients in the two groups were followed up for 12 to 24 months,with an average of(16.29±3.88)months.In PFNA group:incision infection occurred in 1 case after operation and improved after antibiotic treatmeng;Postoperative fracture occurred in 1 case and improved after reoperation.Venous thrombosis of lower extremity occurred in 8 patients and improved after anticoagulation and thrombolysis.Pulmonary infection in 4 patients and urinary tract infection in 1 patient were improved after antibiotic treatment.In InterTAN group:postoperative refracture occurred in 1 case and improved after reoperation,Venous thrombosis of lower extremity occurred in 4 cases and improved after anticoagulation and thrombolysis.Pulmonary infection in 4 patients and urinary tract infection in 2 patients were improved after antibiotic treatment.P=0.000<0.05 for the operation time,intraoperative bleeding volume and incision length,the PFNA group better than the InterTAN group.P=0.000<0.05 for fracture clinical healing time and hip function Harris score in 1 month after operation,the InterTAN group better than the PFNA group.P>0.05 for hospitalization days,Chinese medicine syndrome curative effect evaluation,hip function Harris score at 3,6,12 months after operation and postoperative complications,there was no significant difference between the two groups.Conclusion: PFNA fixation system and InterTAN fixation system can achieve satisfactory results in the treatment of intertrochanteric fractures in the elderly.PFNA fixation system has more advantages than InterTAN fixation system in terms of operation time,incision length and intraoperative bleeding volume.InterTAN fixation system has higher biomechanical stability,and fracture healing time and Harris score in 1 month after operation have obvious advantages.There was no significant difference between the two groups in other aspects.Therefore,patients with poor physical condition and intolerance to prolonged surgery can choose PFNA fixation system,but high quality of life requirements and physical conditions good patients can give priority to InterTAN fixation system.The concept of “paying equal attention to both muscles and bones”in traditional Chinese medicine is the soul that runs through the whole treatment process and has important guiding significance for the treatment of intertrochanteric fractures in the elderly.