Comparison of proximal femoral nail anti-rotation operation in traction bed supine position and non-traction bed lateral position in treatment of intertrochanteric fracture of femur / 中国修复重建外科杂志

ABSTRACT

Objective: To compare the effectiveness of proximal femoral nail anti-rotation (PFNA) in the treatment of intertrochanteric fracture of femur in traction bed supine position and non-traction bed lateral position. Methods: A retrospective analysis of 102 elderly patients with intertrochanteric fracture of femur who met the selection criteria between January 2013 and April 2018 was made. According to the different operative positions, the patients were divided into two groups group A (50 cases, PFNA internal fixation in traction bed supine position) and group B (52 cases, PFNA internal fixation in non-traction bed lateral position). There was no significant difference in age, gender, fracture side, cause of injury, AO classification, complications, and time from injury to operation between the two groups ( P>0.05). The preoperative preparation time, incision length, operation time, intraoperative blood loss, intraoperative X-ray fluoroscopy times, fracture healing time, and complications were recorded and compared between the two groups, and the effectiveness was evaluated by Harris hip score at 1 year after operation. Results: There was no significant difference in incision length between groups A and B ( t=1.116, P=0.268). In addition, the preoperative preparation time, operation time, intraoperative blood loss, and intraoperative X-ray fluoroscopy times in group A were significantly greater than those in group B ( P<0.05). Both groups were followed up 12-14 months, with an average of 13 months. There were 3 postoperative complications in group A and group B respectively. In group A, there were 2 cases of hip joint pain and 1 case of local fat liquefaction (healed after dressing change); in group B, there were 2 cases of hip joint pain and 1 case of deep vein thrombosis in lower extremity; there was no significant difference in the incidence of postoperative complications between the two groups ( P=0.642). The patients of the two groups had a good result of fracture reduction and the internal fixation quality, and there was no main nail loosening, screw fracture, spiral blade cutting, withdrawal, and the nail breakage occurred, and no nonunion of bone, coxa vara, and other complications occurred. X-ray showed that the fracture healed in both groups, and there was no significant difference in fracture healing time between the two groups ( t=1.515, P=0.133). There was no significant difference in Harris hip score between the two groups at 1 year after operation ( t=0.778, P=0.438). Conclusion: Compared with the traction bed supine position, PFNA internal fixation for intertrochanteric fracture of femur in the non-traction bed lateral position has the advantages of short preparation time, short operation time, less intraoperative blood loss, less X-ray fluoroscopy times, and satisfactory postoperative recovery effect.