Application Effect of New Combined Minimally Invasive Hemiarthroplasty in Elderly Patients with Trochanteric Femoral Fractures of Evans Types Ⅲ and Ⅳ

LI Yinpeng; WANG Yin; HAO Ming; CAO Bin; LI Ximing; WU Tao

doi:10.3969/j.issn.1002-3429.2025.10.011

Abstract：Objective To explore the effect of the new combined minimally invasive hemiarthroplasty in the treatment of trochanteric femoral fractures of Evans type Ⅲ and Ⅳ in elderly patients.Methods A total of 103 elderly patients with trochanteric femoral fractures of Evans type Ⅲ and Ⅳ from January 2019 to October 2022 were selected and categorized into a minimally invasive group(n=35),an internal fixation group(n=34),and a replacement group(n=34)based on different surgical procedures.These groups underwent novel combined minimally invasive hemiarthroplasty,proximal femoral nail an-tirotation(PFNA)fixation,and artificial hip replacement,respectively.Perioperative indicators,complications,and excel-lent and good rates of hip joint function were statistically analyzed for the three groups,as well as the thromboelastographic pa-rameters,gait parameters,and Berg Balance Scale(BBS)scores before and after surgery.Results The minimally invasive group and internal fixation group had less intraoperative blood loss,shorter duration of operation,time to ambulation,and length of hospital stay than the replacement group(P<0.01).The postoperative drainage volume in the minimally invasive group was less than that in the replacement group(P<0.05).There was no significant difference in perioperative indicators between the minimally invasive group and the internal fixation group(P>0.05).At 3 d after surgery,the thromboelasto-graphic parameters,including the α angle,K value,and MA value,in the minimally invasive group and internal fixation group were lower than those in the replacement group,while the R value was higher than that in the replacement group(P<0.05).There was no significant difference in thromboelastographic parameters between the minimally invasive group and the internal fixation group at 3 d after surgery(P>0.05).At 6 months after surgery,the walking speed,stance phase,stride length,and BBS score in the minimally invasive group and internal fixation group were superior to those in the replacement group,and superior in the minimally invasive group than in the internal fixation group(P<0.05).There was no significant difference in the overall incidence of complications and the excellent and good rate of hip joint function among the three groups(P>0.05).Conclusion The new combined minimally invasive hemiarthroplasty is effective in improving walking and bal-ance functions in elderly patients with trochanteric femoral fractures of Evans types Ⅲ and Ⅳ,which has minimal impact on coagulation function and high safety.