Comparison on Clinical Effect of Proximal Femoral Nail Antirotation and Femoral Head Replacement in the Elderly with Femoral Intertrochanteric Fractures

LUO Ming; LI Yan; DANG Haifeng; ZHAO Yinan; FAN Junjun; CHANG Yukun; GAO Zilong; GAO Wucai; LU Lili; HAN Li

doi:10.3639/j.issn.2095-3097.2025.06.010

Abstract：Objective To compare differences in the curative effect of proximal femoral nail antirotation(PFNA)and femoral head replacement in the elderly patients with femoral intertrochanteric fractures.Methods A retrospective analysis was performed on the clinical data of 210 elderly patients with femoral intertrochanteric fractures at Air Force Medical Uni-versity Xijing Hospital between January 2023 and February 2024.According to different surgical methods,108 patients un-dergoing PFNA were assigned in group A,while 102 patients undergoing femoral head replacement were assigned in group B.The perioperative indexes,postoperative hidden blood loss,hip function(Harris hip scoring system),levels of bone metabolism indexes[osteocalcin(OC),tartrate-resistant acid phosphatase 5b(TRACP 5b),C-terminal cross-linked peptide(CTX-I)and incidence of postoperative adverse events were compared between the two groups.Results Compared with group B,group A had shorter operation time,lower intraoperative blood loss,and lower postoperative drainage volume(P<0.05).Compared with group B,weight-bearing time and total hospitalization time were longer in group A(P<0.05).At 1d,3d and 7d after surgery,hid-den blood loss in group A was less than that in group B(P<0.05).Hip Harris scores in group A were lower than those in group B at 1 month and 3 months after surgery,while they were higher than those in group B at 12 months after surgery(P<0.05).The difference in Harris score between the two groups was not statistically significant at 6 months after surgery(P>0.05).At 1 month after surgery,the level of serum OC in group A was higher than that in group B,while levels of serum TRACP 5b and CTX-I were lower than those in group B(P<0.05).The difference in incidence of adverse events(surgical site infection,lung infection,urinary tract infection,deep venous thrombosis,hip dislocation,hip pain)between the two groups was not statistically significant(P>0.05).Conclusion Compared with femoral head replacement,PFNA has shorter operation time and less trauma,promotes faster balance of bone metabolism levels,and achieves better long-term recovery of hip function.Femoral head replacement,whereas,offers advantages such as short bed-rest time and quick recovery.