Efficacy of long-stem hemiarthroplasty for elderly unstable intertrochanteric fracture / 中国综合临床

ABSTRACT

Objective:To investigate the clinical effect of long-stem hemiarthroplasty in the treatment of unstable intertrochanteric fracture in elderly patients with severe osteoporosis.Methods:A retrospective analysis was performed on 48 elderly patients with unstable intertrochanteric fractures of the femur with severe osteoporosis in Liaocheng People′s Hospital from April 2017 to April 2019.Twenty three patients received long-stem hemiarthroplasty (LHA group). Twenty five patients were treated with proximal femoral nail anti-rotation (PFNA) (PFNA group). PFNA group was used as the control group.The operative time, intraoperative blood loss, perioperative blood transfusion volume, number of intraoperative fluoroscopy, weight-bearing time after operation, the incidence of postoperative complications, hospitalization time, and Harris hip score of 1, 3, 6, 12 months after surgery, to investigate the efficacy of the application of long-stem hemiarthroplasty.Results:In LHA group, 23 patients were followed up for (18.6±3.9) (range from 12.0 to 26.0) months, and 25 patients in the PFNA group were followed up for (17.8±3.3)(range from 12.0 to 24.0) months.There was no significant difference in follow-up time between the two groups ( Z=-0.552, P=0.581). The operation time of LHA Group (60 (55, 73) h) was longer than that of PFNA Group (55 (50, 60) h). The intraoperative blood loss in LHA Group ((179.35±63.47) mL) was more than that in PFNA Group ((122.80±49.03) mL). The number of fluoroscopy in LHA Group (2 (2, 2) times)was less than that in PFNA Group (16 (14.5, 19.5) times). The time of weight bearing in LHA Group (4 (3, 5) d) was earlier than that in PFNA Group (33 (30, 36) d), and the differences were statistically significant ( Z=2.459, t=3.470, Z=6.216, Z=5.959; all P<0.05). There were no significant differences in perioperative blood transfusion, hospital stay and postoperative complications between the two groups (all P>0.05). Harris hip function score was significantly higher in LHA Group ((76.70±5.96), (82.13±6.38), (85.96±7.16), (88.78±7.67) points) and PFNA Group ((63.80±3.46), (71.56±2.55), (81.60±3.38), (88.08±4.83) points) increased gradually with the increase of follow-up time ( Fintra-group=432.557, Pintra-group<0.001), and the score reached the highest 12 months after operation.Harris hip function score of LHA group was higher than that of PFNA group( Finter-group=25.437, Pinter-group<0.001). There was interaction effect between follow-up time point and operation mode( Finteraction=53.464, Pinteraction<0.001). Conclusion:For the elderly patients with unstable intertrochanteric fracture with severe osteoporosis, the application of lengthened stem hemiarthroplasty can get out of bed early, reduce the complications of bed rest, reduce the number of intraoperative fluoroscopy, and recover the function of hip joint earlier and better with satisfactory results.