Hip hemiarthroplasty versus proximal femoral nail anti-rotation(PFNA)in the treatment of A3.3 intertrochanteric fractures in the elderly
Objective To compare the efficacy of hip hemiarthroplasty(HHA)and proximal femoral nail anti-rotation(PFNA)in the treatment of intertrochanteric fractures with comminuted lateral wall,and to evaluate the benefit-risk based on a multi-criteria decision model.Methods A retrospective analysis was performed on 84 eld-erly patients with A3.3 intertrochanteric fractures admitted to the Second Hospital of Tangshan City,from Sep.2020 to Jun.2022,including 43 males and 41 females aged 68-89 years,with an average age of 73.4 years.There were 63 cases of road traffic injuries,4 falls from height,9 crush injuries by machine and 8 crush injuries by heavy ob-jects.According to the adopted surgical methods,patients were divided into HHA group and PFNA group,with 42 cases in each.In the HHA group,cemented hemi hip prosthesis was implanted via the modified Watson-Jones ap-proach with the patient in lateral position.For the other group,PFNA was performed according to the standard pro-cedures.Related indicators were compared between two groups and a multi-criteria decision model was established based on the HHA treatment for intertrochanteric fractures with external wall comminution.The benefit value,risk value and stability of the decision model were evaluated.Results Compared with PFNA group,the HHA group showed a much longer operation time(min,78.30±12.14 vs.112.39±13.95)and much more intraoperative blood loss(mL,113.14±15.13 vs.285.21±18.19)and postoperative 1 d day drainage volume(mL,31.25±8.97 vs.98.25±9.03),but quicker off-bed activities(d,12.32±3.48 vs.41.26±9.73)and bone healing(week,16.14± 2.16 vs.17.26±2.38),and much shorter length of hospital stay(d,9.6±2.5 vs.15.4±2.6),all revealing signifi-cant difference between two groups(all P＜0.05).The Harris hip score(HHS)and Karnofsky functional status(KPS)scores were all significantly increased after surgery and HHA group showed much higher scores(HHS:78.97±4.95 vs.64.35±4.12;KPS score:82.77±1.52 vs.74.93±1.28,both P＜0.05).The incidence of postop-erative complications was 28.57％(12/42)in the HHA group,significantly lower than that in the PFNA group(64.29％,27/42,P＜0.05).Among the benefit indexes,bone healing time and HHA showed the greatest impact on the patient's conditions,while the incision infection and lower limb venous embolism revealed the greatest impact a-mong the risk indexes.The benefit value,risk value and total benefit-to-risk value of HHA in the treatment of elderly A3.3 intertrochanteric fractures were 72,72 and 72,while the values for PFNA were 64,51 and 57,respectively.The probability of HHA group was 100％higher than that for PFNA group,and the stability of the multi-criteria deci-sion-making model was better.Conclusion For the treatment of elderly patients with A3.3 intertrochanteric frac-tures of the femur,HHA can significantly reduce the probability of multiple complications and improve intraoperative relevant indexes and postoperative quality of life,compared with PFNA which shows shorter operation time and less intraoperative blood loss.The two methods can be well applied in clinical practice according to the actual situation of patients.
Femoral intertrochanteric fracturesHemiarthroplastyProximal femoral nail anti-rotationBenefitRisk
万方数据
维普
