Effects of proximal femoral anti-rotation intramedullary nailing on Harris score, functional recovery and prognosis ofelderly patients with femoral intertrochanteric fracture

doi:10.3969/j.issn.1002-7386.2018.11.006

Abstract：Objective To investigate the effects of proximal femoral anti-rotation intramedullary nailing on Harris score, functional recovery and prognosis of elderly patients with femoral intertrochanteric fracture. Methods A total of 120 elderly patients with femoral intertrochanteric fracture were divided into three groups according to the surgical methods: dynamic hip screw (DHS) group (n=40), proximal femoral locking plate (LPFP) group (n=40) and PFNAⅡgroup (n=40). Harris scores, weight bearing time, length of hospital stay and fracture healing time were observed and compared between two groups. Moreover, the mortality of patients at 30d,1 year after treatment was observed. Results There were no significant differences in Harris scores of typeⅠa among the three groups (P>0. 05). The Harris scores of typeⅠb,Ⅰc and typeⅠd in PFNAⅡgroup were significantly higher than those in DHS group and LPFP group (P<0. 05). The Harris scores of typeⅠc and typeⅠd in LPFP group were significantly higher than those in DHS group (P<0. 05). There were significant differences in Harris scores ofⅠa,Ⅰb,Ⅰc andⅠd between DHS group and LPFP group (P<0. 05). The Harris scores of typeⅠd in PFNAⅡgroup were significantly higher than those of typeⅠb, typeⅠc and typeⅠd (P<0. 05). The load bearing time and length of hospital stay of typeⅠa,Ⅰb,Ⅰc andⅠd in PFNAⅡgroup were significantly shorter than those in DHS group and LPFP group (P<0. 05). The fracture healing time of typeⅠc in PFNAⅡgroup was significantly shorter than that in DHS group,and the fracture healing time of typeⅠd was significantly shorter than that in DHS group and LPFP group (P<0. 05). The load bearing time, length of hospital stay and fracture healing time of typeⅠd in DHS group were significantly higher than those in type Ia and type Ib (P<0. 05). The hospital stay of typeⅠd in LPFP group was significantly higher than that in typeⅠa and type Ib (P<0. 05). The load bearing time of typeⅠc and typeⅠd in PFNAⅡgroup were significantly higher than those of typeⅠa, and that of typeⅠd was significantly higher than that of typeⅠc (P<0. 05). There were significant differences in the length of hospital stay of PFNAⅡgroup among typeⅠa, typeⅠb, typeⅠc and typeⅠd each other (P<0. 05). In addition, the mortality rates at 30d and a year after treatment in PFNAⅡgroup were significantly lower than those in DHS group and LPFP group (P<0. 05). Conclusion The proximal femoral anti-rotation intramedullary nailing is highly effective in treating femoral intertrochanteric fracture in elderly patients,which can not only significantly improve the function of hip joint, decrease load bearing time,length of hospital stay and fracture healing time, but also reduce the mortality rate of patients.