[Objective]To compare the clinical outcomes of hip hemiarthroplasty versus internal fixation with proximal femoral nail an-ti-rotation(PFNA)for femoral intertrochanteric fractures in the elderly.[Methods]A retrospective study was conducted on 128 elderly pa-tients who received surgical treatment for femoral intertrochanteric fractures in our hospital from August 2015 to August 2020.According to the preoperative doctor-patient communication,66 patients received hip hemiarthroplasty(the hemiarthroplasty group),while other 62 pa-tients received PFNA fixation(the PFNA group).The documents regarding to perioperative period,follow-up and images were compared be-tween the two groups.[Results]Although the hemiarthroplasty group proved significantly greater than the PFNA group in terms of operative time[(62.9±5.2)min vs(52.5±4.9)min,P＜0.001],total incision length[(15.1±0.8)cm vs(12.2±0.8)cm,P＜0.001],intraoperative blood loss[(301.8±40.9)ml vs(142.9±20.2)ml,P＜0.001],and length of hospital stay[(13.7±1.1)days vs(12.6±1.5)days,P＜0.001],the former was significantly better than the latter in intraoperative fluoroscopy times[(3.5±1.1)times vs(13.8±2.1)times,P＜0.001]and the ambulation time[(3.4±1.3)days vs(18.0±4.6)days,P＜0.001].In addition,the hemiarthroplasty group regained full weight bearing activity significantly earlier than the PFNA group[(24.0±2.0)days vs(59.4±2.6)days,P＜0.001].The VAS score and Harris score significantly improved in both groups over time(P＜0.05),and the hemiarthroplasty group was significantly superior to the PFNA group in terms of VAS score at all time point after surgery(P＜0.05),and Harris scores at 1 and 3 months after operation(P＜0.05).With respect of imaging,the leg length discrep-ancy in the hemiarthroplasty group significantly reduced at the last follow-up compared with that before surgery.On other hand,the femoral neck shaft angle(FNSA)significantly decreased(P＜0.05),whereas the tip-apex distance(TAD)significantly increased in the PFNA group at the last follow-up compared with those immediately after operation(P＜0.05).[Conclusion]Both hemiarthroplasty and PFNA fixation achieve satisfactory consequences for femoral intertrochanteric fractures in the elderly.In comparison,hemiarthroplasty is more advanta-geous as long as the patient's own conditions permit before surgery.
elderlyfemoral intertrochanteric fractureship hemiarthroplastyproximal femoral nail anti-rotation
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NSTL
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