| Objective: With the increasing problem of aging population,the incidence of hip fractures in the elderly is increasing year by year.There are many treatment methods for elderly femoral intertrochanteric fractures,but the choice of treatment method is still controversial in clinical practice.The aim of this study was to compare the efficacy of bipolar hemiarthroplasty with PFNA for the treatment of unstable intertrochanteric femoral fractures in the elderly,in order to investigate the rational treatment of unstable intertrochanteric femoral fractures in the elderly.Method: Eighty-six elderly patients with unstable intertrochanteric femoral fractures treated with bipolar hemiarthroplasty and PFNA from December 2018 to January 2022 in our hospital were retrospectively selected.They were divided into the bipolar hemiarthroplasty group(BHA group)and the proximal femoral anti-rotation intramedullary nailing group(PFNA group)according to the surgical approach.According to the modified Evens-Jensen staging criteria,all included cases were unstable fractures,31 patients were included in the BHA group,9 in Evans type III,11 in Evans type IV,and 11 in Evans type V;55 patients were included in the PFNA group,15 in Evans type III,27 in Evans type IV,and 13 in Evans type V.The treatment results of the two groups were analyzed according to the length of surgical incision,operation time,intraoperative blood loss,hideen blood loss,postoperative time to the ground,hospital stay,harris score of hip function at 1 month and 6 months after surgery,and the incidence of postoperative complications.Result: The length of surgical incision was(9.39±0.37)cm and(7.52±0.41)cm in the BHA and PFNA groups,respectively;the intraoperative blood loss was(245.00±46.76)ml and(179.51±44.19)ml,respectively;the hidden blood loss was(278.02±75.86)ml and(491.69±153.66)ml,compared with the PFNA group,the BHA group had a larger surgical incision and more intraoperative bleeding,but the amount of hidden blood loss was significantly less than that of the PFNA group,and the difference was statistically significant((P < 0.05).The postoperative time to the ground was(3.84 ± 1.32)days and(6.91 ± 1.44)days in the BHA and PFNA groups,respectively;the length of hospital stay was(7.39 ± 1.33)days and(9.80±1.74)days,the BHA group had an earlier postoperative time to the ground and a shorter hospital stay compared to the PFNA group,with a statistically significant difference((P <0.05).Harris score of hip function at 1 month after surgery was(82.90±3.29)and(76.64±3.56)in the BHA group and PFNA group,respectively,the harris score at 1month after surgery was better in the BHA group than in the PFNA group,and the difference was statistically significant(P < 0.05).There was no statistically significant difference between the two groups in operation time,Harris score of hip function at 6months postoperatively,and the incidence of postoperative complications((P > 0.05).Conclusion:1.PFNA and bipolar hemiarthroplasty are effective methods for the treatment of femoral intertrochanteric fracture in the elderly.For different patients,the two methods have their own advantages.2.PFNA has the advantages of less bleeding and less trauma,so it is suitable for most patients with intertrochanteric femur.3.For comminuted intertrochanteric patients with severe osteoporosis,artificial hip arthroplasty can shorten the postoperative time to the ground,carry out early functional exercise,reduce the risk of bedridden complications and improve the quality of life of the patients.it is also an effective treatment.4.As the condition of most elderly patients with intertrochanteric femur is relatively complex,it should be combined with the actual situation of the patients,such as the patient’s age,complications,fracture type and bone condition,to choose the appropriate mode of operation,to develop a personalized operation plan,so as to achieve satisfactory treatment results. |
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