不同内固定治疗老年不稳定股骨粗隆间骨折患者的近远期疗效 及并发症对比.

Objective: To analyze the short-term and long-term efficacy and complications of different internal fixation in the treatment of elderly patients with unstable intertrochanteric fracture of femur (IFF). Methods: 60 elderly patients with unstable IFF admitted to our hospital from January 2020 to January 2023 were selected as research samples. According to different surgical methods, they were divided into two groups, including 30 cases in PF-LCP group (receiving PF-LCP surgery) and 30 cases in PFNA group (receiving PFNA internal fixation surgery). The surgical conditions, hip function (HHS), bone metabolism indexes and inflammatory factors levels[type I procollagen amino terminal peptide (PINP), type I collagen carboxy terminal peptide (CTX), serum interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α)], quality of life and complications were compared between the two groups. Results: The surgical time, hospital stay and fracture healing time in the PFNA group were shorter than those in PF-LCP group, and the intraoperative blood loss was less (P＜0.05). The HHS score of the two groups at 3 months, 6 months and 12 months after surgery was gradually higher than that before surgery, and the HHS scores in the PFNA group at 3 months and 6 months after surgery were higher than those in the PF-LCP group (P＜0.05). There was no significant difference in HHS score between the two groups at 12 months after surgery (P＞0.05). The PINP level in the two groups at 6 months after surgery was higher than that before surgery, and the PFNA group had higher PINP level than the PF-LCP group (P＜0.05). The levels of CTX, IL-6 and TNF-α were reduced than those before surgery, and the levels in the PFNA group were lower (P＜0.05). At 12 months after surgery, the quality of life scores of the two groups were higher than before surgery, and the PFNA group had higher scores than the PF-LCP group (P＜0.05). After 12 months of follow-up, there were 4 cases of internal fixation failure in PFNA group (including 3 cases of main nail fracture and 1 case of screw blade withdrawal), and the failure rate was 13.33%. There was no case of internal fixation failure in PF-LCP group, and the failure rate of internal fixation in PFNA group was higher than that in control group (P＜0.05). There was no significant difference in the total incidence of other postoperative complications between the two groups (P＞0.05). Conclusion: Both PFNA and PF-LCP can effectively treat unstable IFF in the elderly. Compared with PF-LCP, PFNA has faster postoperative recovery and better short-term efficacy, but the risk of internal fixation failure is relatively greater. [ABSTRACT FROM AUTHOR]