Screw plate fixation, intramedullary fixation and artificial femoral head replacement in the repair of femoral intertrochanteric fractures in the elderly: choice and comparison / 中国组织工程研究

ABSTRACT

BACKGROUND:Nowadays,the internal fixation materials for the clinical treatment of femoral intertrochanteric fractures are broadly divided into two categories intramedulary fixation system and extramedulary fixation system.Artificial femoral head replacement can be selected for unstable intertrochanteric fractures.However,the effects of diverse treatments usualy lack of macroscopical evaluation.OBJECTIVE:To investigate and compare the clinical effects of different surgical treatments for femoral intertrochanteric fractures in the elderly.METHODS:168 elderly patients with intertrochanteric fractures,who were treated in the Department of Orthopedics,Beijing Municipal Corps Hospital of Chinese People's Armed Police Forces from June 2005 to June 2010,were enroled in this study.They were treated by screw plate fixation system (dynamic hip screw,dynamic condylar screw),intramedulary fixation system (Gamma 3 nail,expandable intramedulary nail) and artificial femoral head replacement,including 69 males and 99 females,at the age of 75-94 years,averagely 81.4 years.According to Evans type,there were 20 cases of type Ⅰ,43 cases of type Ⅱ,57 cases of type Ⅲ,33 cases of typeⅣ and 15 cases of type Ⅴ.Operative time,blood loss,weight-bearing ambulation time,and hip function were compared and evaluated in patients of each group.RESULTS AND CONCLUSION:After treatment,patients were folowed up for 14-39 months.At 12 months after treatment,Harris score was used to assess hip function in the affected side.Fracture was healed within 12 months.There was no significant difference in excelent and good rate among four groups (P＞0.05).Operative time and blood loss were significantly better in the expandable intramedulary nail group than in the other groups (P＜ 0.05).Weight-bearing ambulation time was significantly better in the artificial femoral head group than in the other groups (P＜ 0.01).Results suggest that according to fracture typing,in combination with osteoporosis in elderly patients,suitable repair method could improve therapeutic effects for femoral intertrochanteric fractures,and reduce postoperative complications.Dynamic hip screw is firstly selected for Evens types Ⅰ and Ⅱ stable intertrochanteric fractures.The intramedulary fixation system can be selected for unstable intertrochanteric fractures as Evans types Ⅲ-Ⅴ.Artificial hip arthroplasty is good for elderly patients with unstable intertrochanteric fractures as wel as severe osteoporosis.