In recent years, many literatures compared the therapeutic effects of internal fixation and artificial femoral head replacement for treatment of intertrochanteric fractures of femur in the elderly, but their opinions are not uniform. Moreover, many literatures concerned the internal fixations including Richard screw, goose head nail and dynamic hip screw, which may lead to inaccurate conclusions.OBJECTIVE:
To compare the results of Gamma nail and artificial femoral head replacement for intertrochanteric fractures of femur in the elderly, to explore the experiences, indications and complications about artificial femoral head replacement for the intertrochanteric fractures.METHODS:
This study retrospectively analyzed 154 elder patients aged over 80 years old with intertrochanteric comminuted fractures. Of them, 98 cases underwent Gamma nail fixation and 56 cases underwent artificial femoral head replacement. Operation time, hospitalization day, intraoperative bleeding, off-bed time, final hip joint function recovery (Harris score) and incidence of complications after fixation were compared and evaluated for statistical analysis.RESULTS AND CONCLUSION:
Average follow-up periods were respectively 6.6 years and 5.7 years in the Gamma nail group and artificial femoral head group. No significant difference in operation time, hospitalization day and intraoperative bleeding was detected between the two groups (P > 0.05), but significant difference in off-bed time was detectable (P < 0.05). No significant difference in final hip joint function score was observed between the two groups (P > 0.05). No significant differences in complications after fixation such as deep vein thrombosis, pulmonary infection and urinary tract infection were visible between the two groups (P > 0.05). Significant differences in implant loosening or rupture, subsidence, dislocation and inequality in leg length were detected between the two groups (P < 0.05). Artificial femoral head replacement for intertrochanteric fractures of femur in the elderly was helpful to patient ‘s off-bed activities and improved partial patients ’ quality of life. After artificial femoral head replacement, no significant difference in hip joint function recovery was detectable compared with Gamma nail fixation. However, the incidence of early- and middle-stage complications was low. Prosthetic loosening, subsidence and dislocation appeared, and these were difficult to be handled and greatly impacted patient 's daily life. Operation indications and skills should be mastered strictly.RESULTS AND CONCLUSION:
Hu ZX, Li KN, He ZY, Chen ED, Wang XJ. Gamma nail versus artificial femoral head replacement for intertrochanteric comminuted fractures of femur in the elderly. Zhongguo Zuzhi Gongcheng Yanjiu. 2014;18(22):3451-3455.