Comparative efficacy of proximal femoral nail antirotation with metaphyseal expansion or non-expansion in the early treatment of femoral intertrochanteric fracture of the elderly
Objective To compare the efficacy of proximal femoral nail antirotation(PFNA)with metaphyseal expansion or non-expansion in the treatment of femoral intertrochanteric fracture in the elderly.Methods A retrospective cohort study was conducted to analyze the clinical data of 349 elderly patients with femoral intertrochanteric fracture,comprising 168 males and 181 females,aged 60-84 years[(73.5±8.6)years].According to AO fracture classification,108 patients were classified as type A1,164 type A2,and 77 type A3.Of them,168 patients received PFNA with metaphyseal expansion(expansion group),while 181 received PFNA with metaphyseal non-expansion(non-expansion group).The operation time,intraoperative blood loss,recessive blood loss,postoperative drainage volume,total blood loss,intraoperative blood transfusion rate and length of hospital stay were compared between the two groups.Visual analogue scale(VAS)scores preoperatively,at 2 and 6 weeks postoperatively of the two groups were detected.The neck-shaft angle and tip-apex distance were measured preoperatively,immediately after surgery,and at 6 months postoperatively.Harris hip score was evaluated at 1,3,and 6 months postoperatively.Additionally,time to weight-bearing ambulation,fracture healing time,and postoperative complication rate were compared between the two groups.Results All the patients were followed up for 6-10 months[(7.8±1.2)months].The operation time for the expansion group was(69.6±12.4)minutes,significantly longer than(65.3±11.5)minutes of the non-expansion group(P＜0.01).Intraoperativc blood loss,recessive blood loss,postoperative drainage volume and total blood loss were(124.8±16.9)ml,(684.1±95.3)ml,(123.9±25.1)ml and(932.8±125.4)ml respectively,which were more than those of the non-expansion group[(96.3±12.6)ml,(623.4±87.4)ml,(110.6±29.7)ml,and(830.3±112.6)ml](P＜0.01).The intraoperative blood transfusion rate was 50.0％(84/168),higher than 38.1％(69/181)of the non-expansion group(P＜0.05).There was no significant difference in the length of hospital stay between the two groups(P＞0.05).There was no significant difference in VAS scores between the two groups before surgery,at 2 and 6 weeks after surgery(P＞0.05).The VAS scores of the two groups at 2 and 6 weeks after surgery were lower than those before surgery,and there were significantly lower scores at 6 weeks after surgery when compared with those at 2 weeks after surgery(P＜0.05).There were no significant differences in neck-shaft angle and tip-apex distance of the two groups before surgery,immediately after surgery and at 6 months after surgery(P＞0.05).In both groups,the neck-shaft angle immediately after surgery and at 6 months after surgery decreased while the apex distance increased when compared with those before surgery(P＜0.05).Furthermore,significantly lower neck-shaft angle and larger apex distance were observed at 6 months after surgery when compared with those immediately after surgery(P＜0.05).There was no significant difference in Harris hip scores at 1,3 and 6 months after surgery between the two groups(P＞0.05).In both groups,the Harris hip scores at 3 and 6 months after surgery were higher than those at 1 month after surgery(P＜0.05)and the Harris hip scores at 6 months after surgery were higher than that those at 3 months after surgery(P＜0.05).There were no significant differences in time to weight-bearing ambulation,fracture healing time and total postoperative complication rate between the two groups(P＞0.05).Conclusions For the elderly patients with femoral intertrochanteric fractures,PFNA with proximal metaphyseal expansion or non-expansion is equally effective in shortening hospital stay,relieving pain,improving reduction quality,promoting hip function recovery and reducing complication rate.However,PFNA with non-expansion treatment can shorten the operation time,reduce intraoperative blood loss,recessive blood loss,postoperative drainage volume and total blood loss,and lower intraoperative blood transfusion rate.
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