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.	吳亮, 虞佩, 王蕾. 側臥位與仰臥位股骨近端防旋髓內釘固定治療股骨轉子間骨折的療效比較. 中華創傷骨科雜志, 2016, 18(5): 401-406.
2.	李繼慶, 張林村, 散軍成, 等. 股骨近端防旋髓內釘與加壓滑動鋼板治療老年股骨粗隆間骨折的療效觀察. 創傷外科雜志, 2016, 18(2): 69-71.
3.	蔡保塔, 徐成毅, 曹軍, 等. 三種內固定方式治療老年股骨轉子間骨折的療效比較. 中華創傷骨科雜志, 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.	榮國威, 王承武, 王滿宜, 等. 骨折. 北京: 人民衛生出版社, 2004: 908.
6.	董俊杰, 舒鈞. 骨質疏松性股骨粗隆間骨折的綜合治療進展. 中國骨質疏松雜志, 2013, 19(6): 635-640.
7.	董佩龍, 唐曉波, 王健, 等. 股骨近端防旋髓內釘與骨水泥柄人工股骨頭置換治療老年股骨粗隆間骨折的療效分析. 中華關節外科雜志(電子版), 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, 陳云豐, 章偉, 等. InterTan 髓內釘治療老年股骨轉子間骨折的失敗原因分析. 中華創傷骨科雜志, 2014, 16(8): 674-678.
10.	馬偉, 曲成明, 崔林江, 等. Ⅲ 型標準伽瑪(γ)型髓內釘與股骨近端鎖定板治療股骨粗隆間骨折的比較研究. 中國骨與關節損傷雜志, 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.	張鵬, 陳經勇, 李鐘, 等. 翻修柄人工股骨頭置換術治療高齡不穩定型股骨粗隆間骨折. 中國骨傷, 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, 趙德偉, 等. ALCP、PFNA-Ⅱ、InterTan 內固定治療股骨粗隆間骨折的療效比較. 中國骨與關節損傷雜志, 2016, 31(6): 588-590.
17.	李青松, 袁曉偉, 金敬堯, 等. 股骨近端防旋髓內釘與股骨近端鎖定鋼板治療股骨粗隆間骨折療效比較. 中國骨與關節損傷雜志, 2016, 31(6): 25-26[核對].
18.	李書振, 陳躍平, 崔偉, 等. 雙極股骨頭置換術治療老年不穩定股骨粗隆間骨折的預后療效分析. 中華關節外科雜志(電子版), 2013, 7(5): 47-50.
19.	王子越, 董啟榕, 徐又佳, 等. 人工股骨頭置換與內固定治療高齡患者無移位型股骨頸骨折的療效比較. 中華創傷骨科雜志, 2016, 18(5): 369-374.

1. 吳亮, 虞佩, 王蕾. 側臥位與仰臥位股骨近端防旋髓內釘固定治療股骨轉子間骨折的療效比較. 中華創傷骨科雜志, 2016, 18(5): 401-406.
2. 李繼慶, 張林村, 散軍成, 等. 股骨近端防旋髓內釘與加壓滑動鋼板治療老年股骨粗隆間骨折的療效觀察. 創傷外科雜志, 2016, 18(2): 69-71.
3. 蔡保塔, 徐成毅, 曹軍, 等. 三種內固定方式治療老年股骨轉子間骨折的療效比較. 中華創傷骨科雜志, 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. 榮國威, 王承武, 王滿宜, 等. 骨折. 北京: 人民衛生出版社, 2004: 908.
6. 董俊杰, 舒鈞. 骨質疏松性股骨粗隆間骨折的綜合治療進展. 中國骨質疏松雜志, 2013, 19(6): 635-640.
7. 董佩龍, 唐曉波, 王健, 等. 股骨近端防旋髓內釘與骨水泥柄人工股骨頭置換治療老年股骨粗隆間骨折的療效分析. 中華關節外科雜志(電子版), 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, 陳云豐, 章偉, 等. InterTan 髓內釘治療老年股骨轉子間骨折的失敗原因分析. 中華創傷骨科雜志, 2014, 16(8): 674-678.
10. 馬偉, 曲成明, 崔林江, 等. Ⅲ 型標準伽瑪(γ)型髓內釘與股骨近端鎖定板治療股骨粗隆間骨折的比較研究. 中國骨與關節損傷雜志, 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. 張鵬, 陳經勇, 李鐘, 等. 翻修柄人工股骨頭置換術治療高齡不穩定型股骨粗隆間骨折. 中國骨傷, 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, 趙德偉, 等. ALCP、PFNA-Ⅱ、InterTan 內固定治療股骨粗隆間骨折的療效比較. 中國骨與關節損傷雜志, 2016, 31(6): 588-590.
17. 李青松, 袁曉偉, 金敬堯, 等. 股骨近端防旋髓內釘與股骨近端鎖定鋼板治療股骨粗隆間骨折療效比較. 中國骨與關節損傷雜志, 2016, 31(6): 25-26[核對].
18. 李書振, 陳躍平, 崔偉, 等. 雙極股骨頭置換術治療老年不穩定股骨粗隆間骨折的預后療效分析. 中華關節外科雜志(電子版), 2013, 7(5): 47-50.
19. 王子越, 董啟榕, 徐又佳, 等. 人工股骨頭置換與內固定治療高齡患者無移位型股骨頸骨折的療效比較. 中華創傷骨科雜志, 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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