Efficacy comparison of different methods to treat femoral intertrochanteric fracture in aged patients_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LI Mingdong ¹ , HU Jijie ² , LI Zaomin ¹ , CHEN Jianfei ¹ ,  GAO Xing ³ , LIU Jian ⁴

1. Department of Orthopedic Trauma, Hainan General Hospital, Haikou Hainan, 570311, P.R.China;
2. Department of Orthopaedics and Traumatology, Nanfang Hospital, Nanfang Medical University, Guangzhou Guangdong, 510515, P.R.China;
3. International Nursing College, Hainan Medical University, Haikou Hainan, 571199, P.R.China;
4. Department of Orthopedic Spine, Hainan General Hospital, Haikou Hainan, 570311, P.R.China;

Corresponding author：

GAO Xing, Email: xingxing9804@163.com

Keywords：

Femoral intertrochanteric fracture; locking compression plate; proximal femoral nail anti-rotation; artificial femoral head replacement; aged patients

DOI：

10.7507/1002-1892.201703047

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ObjectiveTo compare the efficacy of proximal femoral nail anti-rotation (PFNA), locking compression plate (LCP), and artificial femoral head replacement for femoral intertrochanteric fracture in aged patients so as to provide reference for clinical treatment.MethodsA retrospective analysis was made on the clinical data of 150 aged patients with femoral intertrochanteric fracture treated between September 2009 and March 2016. PFNA was used in 51 cases (group A), LCP in 53 cases (group B), and artificial femoral head replacement in 46 cases (group C). There was no significant difference in sex, age, side, cause of injury, injury to operation time, type of fracture, and combined medical diseases between groups (P>0.05). The incision length, operation time, intraoperative blood loss, time for full weight bearing, hip Harris score, and complications were recorded and compared between groups.ResultsThe patients were followed up 12-23 months (mean, 18.6 months) in group A, 12-25 months (mean, 19.0 months) in group B, and 12-24 months (mean, 18.9 months) in group C. The incision length, operation time, and intraoperative blood loss of group A were significantly less than those of groups B and C (P<0.05); the operation time of group C was significantly shorter than that of group B (P<0.05), but there was no significant difference in incision length and intraoperative blood loss (P>0.05). The time for full weight bearing was significantly shorter in group C than groups A and B, and in group A than group B (P<0.05). Postoperative complications occurred in 11 patients of group A (21.6%), 14 patients of group B (26.4%), and 2 patients of group C (4.3%), showing significant difference between group C and group A or group B (P<0.05), but no significant difference was found between groups A and B (P>0.05). Hip Harris score at 12 months after operation had no significant difference between groups (P>0.05).ConclusionPFNA, LCP, and artificial femoral head replacement are all effective methods to treat femoral intertrochanteric fracture in aged patients. PFNA has the advantages of small incision, short operation time, less bleeding and simple procedure, and artificial femoral head replacement has the advantages of early time for full weight bearing, less bed rest time, and less complications. For these patients, PFNA and artificial femoral head replacement are appropriate.

Citation： LI Mingdong, HU Jijie, LI Zaomin, CHEN Jianfei, GAO Xing, LIU Jian. Efficacy comparison of different methods to treat femoral intertrochanteric fracture in aged patients. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(6): 653-658. doi: 10.7507/1002-1892.201703047 Copy

1.	吴亮, 虞佩, 王蕾. 侧卧位与仰卧位股骨近端防旋髓内钉固定治疗股骨转子间骨折的疗效比较. 中华创伤骨科杂志, 2016, 18(5): 401-406.
2.	李继庆, 张林村, 散军成, 等. 股骨近端防旋髓内钉与加压滑动钢板治疗老年股骨粗隆间骨折的疗效观察. 创伤外科杂志, 2016, 18(2): 69-71.
3.	蔡保塔, 徐成毅, 曹军, 等. 三种内固定方式治疗老年股骨转子间骨折的疗效比较. 中华创伤骨科杂志, 2016, 18(7): 564-568.
4.	Xu Y, Geng D, Yang H, et al. Treatment of unstable proximal femoral fractures: comparison of the proximal femoral nail antirotationand gamma nail 3. Orthopedics, 2010, 33(7): 473.
5.	荣国威, 王承武, 王满宜, 等. 骨折. 北京: 人民卫生出版社, 2004: 908.
6.	董俊杰, 舒钧. 骨质疏松性股骨粗隆间骨折的综合治疗进展. 中国骨质疏松杂志, 2013, 19(6): 635-640.
7.	董佩龙, 唐晓波, 王健, 等. 股骨近端防旋髓内钉与骨水泥柄人工股骨头置换治疗老年股骨粗隆间骨折的疗效分析. 中华关节外科杂志(电子版), 2016, 10(1): 37-42.
8.	Rupprecht M, Grossterlinden L, Ruecker AH, et al. A comparative biomechanical analysis of fixation devices for unstable femoral neck fractures: the Intertan versus cannulated screws or a dynamic hip screw. J Trauma, 2011, 71(3): 625-634.
9.	潘垚, 陈云丰, 章伟, 等. InterTan 髓内钉治疗老年股骨转子间骨折的失败原因分析. 中华创伤骨科杂志, 2014, 16(8): 674-678.
10.	马伟, 曲成明, 崔林江, 等. Ⅲ 型标准伽玛(γ)型髓内钉与股骨近端锁定板治疗股骨粗隆间骨折的比较研究. 中国骨与关节损伤杂志, 2016, 31(4): 401-402.
11.	Fung W, Jonsson A, Buhren V, et al. Classifying intertrochanteric fractures of the proximal femur: does experience matter? Med Princ Pract, 2007, 16(3): 198-202.
12.	张鹏, 陈经勇, 李钟, 等. 翻修柄人工股骨头置换术治疗高龄不稳定型股骨粗隆间骨折. 中国骨伤, 2013, 26(12): 989-991.
13.	Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg (Am), 1969, 51(4): 737-755.
14.	Pu JS, Liu L, Wang GL, et al. Results of the proximal femoral nail anti-rotation (PFNA) in elderly Chinese patients. Int Orthop, 2009, 33(5): 1441-1444.
15.	Mereddy P, Kamath S, Ramakrishnan M, et al. The AO/ASIF proximal femoral nail antirotation (PFNA): a new design for the treatment of unstable proximal femoral fractures. Injury, 2009, 40(4): 428-432.
16.	辛培成, 李明, 赵德伟, 等. ALCP、PFNA-Ⅱ、InterTan 内固定治疗股骨粗隆间骨折的疗效比较. 中国骨与关节损伤杂志, 2016, 31(6): 588-590.
17.	李青松, 袁晓伟, 金敬尧, 等. 股骨近端防旋髓内钉与股骨近端锁定钢板治疗股骨粗隆间骨折疗效比较. 中国骨与关节损伤杂志, 2016, 31(6): 25-26[核对].
18.	李书振, 陈跃平, 崔伟, 等. 双极股骨头置换术治疗老年不稳定股骨粗隆间骨折的预后疗效分析. 中华关节外科杂志(电子版), 2013, 7(5): 47-50.
19.	王子越, 董启榕, 徐又佳, 等. 人工股骨头置换与内固定治疗高龄患者无移位型股骨颈骨折的疗效比较. 中华创伤骨科杂志, 2016, 18(5): 369-374.

1. 吴亮, 虞佩, 王蕾. 侧卧位与仰卧位股骨近端防旋髓内钉固定治疗股骨转子间骨折的疗效比较. 中华创伤骨科杂志, 2016, 18(5): 401-406.
2. 李继庆, 张林村, 散军成, 等. 股骨近端防旋髓内钉与加压滑动钢板治疗老年股骨粗隆间骨折的疗效观察. 创伤外科杂志, 2016, 18(2): 69-71.
3. 蔡保塔, 徐成毅, 曹军, 等. 三种内固定方式治疗老年股骨转子间骨折的疗效比较. 中华创伤骨科杂志, 2016, 18(7): 564-568.
4. Xu Y, Geng D, Yang H, et al. Treatment of unstable proximal femoral fractures: comparison of the proximal femoral nail antirotationand gamma nail 3. Orthopedics, 2010, 33(7): 473.
5. 荣国威, 王承武, 王满宜, 等. 骨折. 北京: 人民卫生出版社, 2004: 908.
6. 董俊杰, 舒钧. 骨质疏松性股骨粗隆间骨折的综合治疗进展. 中国骨质疏松杂志, 2013, 19(6): 635-640.
7. 董佩龙, 唐晓波, 王健, 等. 股骨近端防旋髓内钉与骨水泥柄人工股骨头置换治疗老年股骨粗隆间骨折的疗效分析. 中华关节外科杂志(电子版), 2016, 10(1): 37-42.
8. Rupprecht M, Grossterlinden L, Ruecker AH, et al. A comparative biomechanical analysis of fixation devices for unstable femoral neck fractures: the Intertan versus cannulated screws or a dynamic hip screw. J Trauma, 2011, 71(3): 625-634.
9. 潘垚, 陈云丰, 章伟, 等. InterTan 髓内钉治疗老年股骨转子间骨折的失败原因分析. 中华创伤骨科杂志, 2014, 16(8): 674-678.
10. 马伟, 曲成明, 崔林江, 等. Ⅲ 型标准伽玛(γ)型髓内钉与股骨近端锁定板治疗股骨粗隆间骨折的比较研究. 中国骨与关节损伤杂志, 2016, 31(4): 401-402.
11. Fung W, Jonsson A, Buhren V, et al. Classifying intertrochanteric fractures of the proximal femur: does experience matter? Med Princ Pract, 2007, 16(3): 198-202.
12. 张鹏, 陈经勇, 李钟, 等. 翻修柄人工股骨头置换术治疗高龄不稳定型股骨粗隆间骨折. 中国骨伤, 2013, 26(12): 989-991.
13. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg (Am), 1969, 51(4): 737-755.
14. Pu JS, Liu L, Wang GL, et al. Results of the proximal femoral nail anti-rotation (PFNA) in elderly Chinese patients. Int Orthop, 2009, 33(5): 1441-1444.
15. Mereddy P, Kamath S, Ramakrishnan M, et al. The AO/ASIF proximal femoral nail antirotation (PFNA): a new design for the treatment of unstable proximal femoral fractures. Injury, 2009, 40(4): 428-432.
16. 辛培成, 李明, 赵德伟, 等. ALCP、PFNA-Ⅱ、InterTan 内固定治疗股骨粗隆间骨折的疗效比较. 中国骨与关节损伤杂志, 2016, 31(6): 588-590.
17. 李青松, 袁晓伟, 金敬尧, 等. 股骨近端防旋髓内钉与股骨近端锁定钢板治疗股骨粗隆间骨折疗效比较. 中国骨与关节损伤杂志, 2016, 31(6): 25-26[核对].
18. 李书振, 陈跃平, 崔伟, 等. 双极股骨头置换术治疗老年不稳定股骨粗隆间骨折的预后疗效分析. 中华关节外科杂志(电子版), 2013, 7(5): 47-50.
19. 王子越, 董启榕, 徐又佳, 等. 人工股骨头置换与内固定治疗高龄患者无移位型股骨颈骨折的疗效比较. 中华创伤骨科杂志, 2016, 18(5): 369-374.

Chinese Journal of Reparative and Reconstructive Surgery

Efficacy comparison of different methods to treat femoral intertrochanteric fracture in aged patients

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