ABSTRACT
Objective To examine the difference in the effectiveness between proximal femoral nail anti-rotation (PFNA) and femoral head replacement (FHR) of intertrochanteric fracture in elderly patients.Methods This study collected 69 patients that underwent PFNA or FHR after intertrochanteric fractures between June 2012 and September 2014.PFNA group was composed of 41 subjects (17 males and 24 females) aged 80-101 years (mean,86.7 years),and time from injury to operation was (3.12 ± 0.95)days.FHR group was composed of 28 subjects (13 males and 15 females) aged 80-99 years (mean,87.2 years),and time from injury to operation was (3.2 ± 1.0) days.Comparison of operation time,intraoperative blood loss,postoperative blood transfusion,off-bed time,complication incidence,hemoglobin concentration and hip function was made between groups.Results Duration of follow-up was 1-3 years (mean,1.8 years).Operation time and intraoperative blood loss in PFNA group were (46.8 ± 4.4) minutes and (77.0 ± 24.2) ml respectively,differed from (57.4 ± 5.9) minutes and (150.7 ± 46.5) ml in FHR group (P ＜ 0.05).Three days after operation,a similar decrease in hemoglobin concentration was seen in PFNA group [(21.3 ±6.1)g/L] and FHR group [(23.2 ±5.8)g/L] (P ＞ 0.05).Off-bed time in FHR group was (3.2 ± 1.2) days,shorter than (7.1-± 2.5) days in PFNA group (P ＜ 0.05).Incidence of postoperative complications in FHR group was 14％,lower than 37％ in PFNA group (P ＜ 0.05).Hip function of the two groups presented no significant difference six months after operation,but the proportion of excellent results in FHR group was higher than that in PFNA group (82％ vs.73％) (P ＞ 0.05).Conclusion FHR provides better results over PFNA regarding off-bed time,complication incidence and hip function,and hence is preferred for the treatment of elderly patients with intertrochanteric fractures,especially in those with severe osteoporosis.
ABSTRACT
Objective To explore the differences between the conservative treatment and the operative treatment in the management of cervical spinal cord injury, and the timing of the operation. Methods The therapeutic effectiveness o f the 45 cases who were treated from October 1996 to January 2002 was analyzed. 21 of them underwent conservative treatment and 24 operative treatment. The corr elation between the therapeutic effects of the operation and its timing was expl ored. Results The myeloid functional recovery was poor in the patients who had b een treated with conservative means but good in those who had been given an oper ation. The earlier the operation, the more effective it could be, and the higher the probability of the myeloid functional recovery. Conclusions The operative treatment promises better outcome than the conservative treatment. To get the be st effects, the operation should be done within one month after the injury, for the longer the lapse between the injury and the operation, the worse the effect.