RESUMO
Objective:To compare the clinical efficacy between proximal femoral biomimetic intramedullary nail (PFBN) and traditional proximal femoral anti-rotation intramedullary nail (PFNA) in the treatment of senile osteoporotic intertrochanteric fractures.Methods:The data were retrospectively analyzed of the 92 elderly patients with osteoporotic intertrochanteric fracture who had been treated at Department of Orthopedics, People's Hospital of Xinjiang Uygur Autonomous Region from April to October in 2021. According to their internal fixation methods, the patients were divided into 2 groups.In the PFBN group of 46 patients, there were 22 males and 24 females, with an age of (75.7±5.2) years and time from injury to operation of (3.1±0.4) d; in the PFNA group of 46 patients, there were 20 males and 26 females, with an age of (75.3±4.2) years and time from injury to operation of (3.3±0.5) d. Recorded were the operation time, intraoperative blood loss, hospital stay, fracture reduction quality, postoperative weight bearing time, hip function and complications at the last follow-up.Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability ( P>0.05). The operation time in the PFBN group was (47.3±11.4) min, significantly longer than that in the PFNA group [(39.2±15.3) min] ( P<0.05); the postoperative weight-bearing time in the former was (7.9±2.7) d, significantly shorter than that in the PFNA group [(21.2±5.7) d] ( P<0.05). There were no significant differences between the 2 groups in the intraoperative blood loss [(130.6±21.3) mL versus (123.5±17.8) mL], hospital stay [(4.2±1.6) d versus (4.6±2.1) d], the excellent and good rate of Francisco score [89.1% (41/46) versus 87.0% (40/46)], fracture healing time [(12.3±0.5) weeks versus (12.6±0.7) weeks], or the excellent and good rate of Harris hip score at the last follow-up [89.1% (41/46) versus 87.0% (40/46)] (all P>0.05). Conclusion:Both PFBN and PFNA can achieve satisfactory clinical results in the treatment of osteoporotic intertrochanteric fractures in the elderly patients, but PFBN may provide more reliable early stability and reduce patient bedtime than PFNA.
RESUMO
BACKGROUND:The number of elderly patients with hip fracture is huge, and this population mainly combines with a variety of internal diseases. The general condition was bad. Compared to total hip arthroplasty, bipolar hemiarthroplasty can shorten operation time, reduce the time of anesthesia and improve surgical safety, but the operation using which fixation mode is always controversial. OBJECTIVE:To compare the safety and curative effects of bipolar hemiarthroplasty with cementless or cement femoral stem prosthesis in elderly patients with osteoporotic complex hip fracture. METHODS:From June 2007 to June 2010, 198 elderly patients with osteoporotic hip fracture aged more than 75 years old, who were treated with bipolar hemiarthroplasty in the People’s Hospital of Xinjiang Uygur Autonomous Region, China, were enroled in this study. Al patients were divided into cementless group (n=69) and cement group (n=129) according to the type of prognosis. Osteoporosis was treated conventionaly in both groups after replacement. Operation time, intraoperative blood loss, incidence of postoperative hip pain, out of bed activity time post surgery, Harris scores of last folow-up and loosening rate of the prognosis were compared between the two groups. RESULTS AND CONCLUSION:176 of above 198 cases were folowed up for 48 to 84 months, including 122 in the cement group and 54 in the cementless group. Operation time was longer in the cement group than in the cementless group, but out of bed time was earlier in the cement group than in the cementless group post surgery, and there were significant differences (P 0.05). The incidences of loosening rate were 5% and 4% in the cement and cementless groups, respectively, which showed significant differences (P< 0.05). These results indicate that bipolar hemiarthroplasty with or without cement for osteoporotic hip fracture in the elderly can obtain good middle- and long-term effects. Bipolar hemiarthroplasty with cement can reduce the out of bed time, but operation time was longer, and incidences of hip pain and loosening were higher in cement prosthesis than in cementless prosthesis.