Comparison of the effect of proximal femoral nail anti-rotation and dynamic hip screws in intertrochanteric fracture in elderly patients with osteoporosis_West China Medical Journal

Authors：

HE Xin , HUANG Qiang , LI Zhengjiang , LI Yongkui ,  GU Qishan

Department of Orthopaedics, the Fifth People’s Hospital of Chengdu, Chengdu, Sichuan 611130, P. R. China;

Corresponding author：

GU Qishan, Email: CDWYYGK@foxmail.com

Keywords：

Intertrochanteric fracture; Proximal femoral nail anti-rotation; Osteoporosis

DOI：

10.7507/1002-0179.201508064

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To compare the effect of proximal femoral nail anti-rotation (PFNA) and dynamic hip screw (DHS) in the treatment of intertrochanteric fracture in elderly patients with osteoporosis. Methods A total of 72 elderly patients with intertrochanteric fractures were enrolled between December 2011 and December 2014. According to the different surgical methods, the patients were divided into PFNA group (38 cases) and DHS group (34 cases). The operation time, perioperative blood loss, postoperative weight-bearing time, Harris score were compared between the two groups. Results All cases were followed up for 5–24 months (mean, 13.5 months). The operation time in PFNA group was shorter than that in DHS group [(40.25±24.23) vs. (72.65±34.65) minutes], the perioperative blood loss in PFNA group was less than that in DHS group [(136±56) vs. (256±102) mL], the postoperative weight-bearing time in PFNA group was earlier than that in DHS group [(5.24±4.52) vs. (15.69±6.78) days], and the Harris score in PFNA group was higher than that in DHS group (80.23±10.26 vs. 54.75±12.37) ; the differences above were all statistically significant (P<0.05). Conclusion Elderly patients with intertrochanteric fracture and osteoporosis treated with PFNA have shorter operation time, less wounds, better hip function, and earlier weight-bearing than the patients treated with DHS; the surgical method can improve the patient′ life quality.

Citation： HE Xin, HUANG Qiang, LI Zhengjiang, LI Yongkui, GU Qishan. Comparison of the effect of proximal femoral nail anti-rotation and dynamic hip screws in intertrochanteric fracture in elderly patients with osteoporosis. West China Medical Journal, 2017, 32(8): 1208-1211. doi: 10.7507/1002-0179.201508064 Copy

1.	Xu YZ, Geng DC, Mao HQ, et al. A comparison of the proximal femoral nail antirotation device and dynamic hip screw in the treatment of unstable pertrochanteric fracture. J Int Med Res, 2010, 38(4): 1266-1275.
2.	Akıncı O, Akalın Y, Reisoğlu A, et al. Comparison of long-term results of dynamic hip screw and AO 130 degrees blade plate in adult trochanteric region fractures. Acta Orthop Traumatol Turc, 2010, 44(6): 443-451.
3.	李正疆, 张焱, 顾琪珊, 等. 成都市温江区老年骨质疏松性骨折的流行病学调查. 四川医学, 2015, 2(36): 156-157.
4.	刘忠厚, 杨定焯, 朱汉民, 等. 中国人骨质疏松症建议诊断标准(第二稿). 中国骨质疏松杂志, 2000, 1(6): 1-3.
5.	Hwang JH, Oh JK, Han SH, et al. Mismatch between PFNa and medullary canal causing difficulty in nailing of the pertrochanteric fractures. Arch Orthop Trauma Surg, 2008, 128(12): 1443-1446.
6.	石永新, 李富琴, 谭文甫, 等. 股骨近端防旋髓内钉与锁定加压接骨板治疗老年外侧壁薄弱型股骨粗隆间骨折疗效比较. 中国修复重建外科杂志, 2014, 28(10): 1199-1203.
7.	Konstantinidis L, Papaioannou C, Mehlhorn A, et al. Salvage procedures for trochanteric femoral fractures after internal fixation failure: biomechanical comparison of a plate fixator and the dynamic condylar screw. Proc Inst Mech Eng H, 2011, 225(7): 710-717.
8.	苏文珍, 林永杰, 孙立民, 等. PFNA、DHS 与 FHR 治疗老年股骨粗隆间骨折的疗效比较. 医学与哲学, 2014, 35(497): 26-29.
9.	王愉思, 何畔, 魏磊平, 等. 人工股骨头置换与 DHS 内固定治疗高龄不稳定股骨粗隆间骨折的随机对照研究. 中国骨与关节损伤杂志, 2010, 25(10): 869-872.
10.	Shen L, Zhang Y, Shen Y, et al. Antirotation proximal femoral nail versus dynamic hip screw for intertrochanteric fractures: a meta-analysis of randomized controlled studies. Orthop Traumatol Surg Res, 2013, 99(4): 377-383.
11.	Curtis MJ, Jinnah RH, Wilson V, et al. Proximal femoral fractures: a biomechanical study to compare intramedullary and extramedullary fixation. Injury, 1994, 25(2): 99-104.
12.	Sahin EK, Imerci A, Kınık H, et al. Comparison of proximal femoral nail antirotation (PFNA) with AO dynamic condylar screws (DCS) for the treatment for unstable peritrochanteric femoral fractures. Eur J Orthop Surg Traumatol, 2014, 24(3): 347-352.
13.	武斌, 梁杰, 杜远立, 等. 髋关节置换与动力髋螺钉内固定治疗高龄股骨粗隆间骨折疗效观察. 中国矫形外科杂志, 2012, 20(20): 1900-1902.
14.	韦旭明, 孙振中, 宋骁军. 经皮加压钢板与股骨近端防旋髓内钉治疗外侧壁危险型股骨粗隆间骨折的病例对照研究. 中国骨伤, 2013, 26(12): 981-984.
15.	朱汉民. 双膦酸盐和骨质疏松. 中国实用内科杂志, 2011, 31(7): 517-520.
16.	何成奇, 熊恩富, 熊素芳, 等. 骨质疏松症的运动防治. 国外医学: 物理医学与康复学分册, 2000, 20(1): 7-9.

1. Xu YZ, Geng DC, Mao HQ, et al. A comparison of the proximal femoral nail antirotation device and dynamic hip screw in the treatment of unstable pertrochanteric fracture. J Int Med Res, 2010, 38(4): 1266-1275.
2. Akıncı O, Akalın Y, Reisoğlu A, et al. Comparison of long-term results of dynamic hip screw and AO 130 degrees blade plate in adult trochanteric region fractures. Acta Orthop Traumatol Turc, 2010, 44(6): 443-451.
3. 李正疆, 张焱, 顾琪珊, 等. 成都市温江区老年骨质疏松性骨折的流行病学调查. 四川医学, 2015, 2(36): 156-157.
4. 刘忠厚, 杨定焯, 朱汉民, 等. 中国人骨质疏松症建议诊断标准(第二稿). 中国骨质疏松杂志, 2000, 1(6): 1-3.
5. Hwang JH, Oh JK, Han SH, et al. Mismatch between PFNa and medullary canal causing difficulty in nailing of the pertrochanteric fractures. Arch Orthop Trauma Surg, 2008, 128(12): 1443-1446.
6. 石永新, 李富琴, 谭文甫, 等. 股骨近端防旋髓内钉与锁定加压接骨板治疗老年外侧壁薄弱型股骨粗隆间骨折疗效比较. 中国修复重建外科杂志, 2014, 28(10): 1199-1203.
7. Konstantinidis L, Papaioannou C, Mehlhorn A, et al. Salvage procedures for trochanteric femoral fractures after internal fixation failure: biomechanical comparison of a plate fixator and the dynamic condylar screw. Proc Inst Mech Eng H, 2011, 225(7): 710-717.
8. 苏文珍, 林永杰, 孙立民, 等. PFNA、DHS 与 FHR 治疗老年股骨粗隆间骨折的疗效比较. 医学与哲学, 2014, 35(497): 26-29.
9. 王愉思, 何畔, 魏磊平, 等. 人工股骨头置换与 DHS 内固定治疗高龄不稳定股骨粗隆间骨折的随机对照研究. 中国骨与关节损伤杂志, 2010, 25(10): 869-872.
10. Shen L, Zhang Y, Shen Y, et al. Antirotation proximal femoral nail versus dynamic hip screw for intertrochanteric fractures: a meta-analysis of randomized controlled studies. Orthop Traumatol Surg Res, 2013, 99(4): 377-383.
11. Curtis MJ, Jinnah RH, Wilson V, et al. Proximal femoral fractures: a biomechanical study to compare intramedullary and extramedullary fixation. Injury, 1994, 25(2): 99-104.
12. Sahin EK, Imerci A, Kınık H, et al. Comparison of proximal femoral nail antirotation (PFNA) with AO dynamic condylar screws (DCS) for the treatment for unstable peritrochanteric femoral fractures. Eur J Orthop Surg Traumatol, 2014, 24(3): 347-352.
13. 武斌, 梁杰, 杜远立, 等. 髋关节置换与动力髋螺钉内固定治疗高龄股骨粗隆间骨折疗效观察. 中国矫形外科杂志, 2012, 20(20): 1900-1902.
14. 韦旭明, 孙振中, 宋骁军. 经皮加压钢板与股骨近端防旋髓内钉治疗外侧壁危险型股骨粗隆间骨折的病例对照研究. 中国骨伤, 2013, 26(12): 981-984.
15. 朱汉民. 双膦酸盐和骨质疏松. 中国实用内科杂志, 2011, 31(7): 517-520.
16. 何成奇, 熊恩富, 熊素芳, 等. 骨质疏松症的运动防治. 国外医学: 物理医学与康复学分册, 2000, 20(1): 7-9.

West China Medical Journal

Comparison of the effect of proximal femoral nail anti-rotation and dynamic hip screws in intertrochanteric fracture in elderly patients with osteoporosis

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