Comparison of internal fixation and joint replacement for treating intertrochanteric fractures of cerebral infarction hemiplegia side in older adults

doi:10.3969/j.issn.2095-4344.2900

Abstract

Abstract:

BACKGROUND: Intertrochanteric fracture of cerebral infarction hemiplegia side in older adults is a special type of intertrochanteric fracture. There are three surgical treatments: intramedullary fixation, plate fixation, and joint replacement. However, there are few related literatures about it, which are inconclusive and controversial.

OBJECTIVE: To compare the clinical efficacy of Intertrochanteric Antegrade Nailing System (InterTAN, Smith & Nephew), proximal femoral locking compression plate and cemented hemiarthroplasty in the treatment of senile cerebral infarction with hemiplegic intertrochanteric fracture.

METHODS: Clinical data of 88 cases of intertrochanteric femoral fractures combined with hemiplegia due to cerebral infarction treated in the Affiliated Hospital of Chengde Medical University from October 2010 to October 2017 were retrospectively analyzed. The subjects were divided into three groups according to treatment methods. There were 24 patients in the InterTAN group, and 35 patients in the proximal femoral locking compression plate group, and 29 patients in the arthroplasty group. Operation time, intraoperative blood loss, hemoglobin differences before and after operation, postoperative bed rest time, perioperative complication rate, and Harris score at 6 and 12 months after operation were compared among the three groups.

RESULTS AND CONCLUSION: (1) Operation time was shorter in the InterTAN group than that in the proximal femoral locking compression plate group and the replacement group (P < 0.05). Intraoperative blood loss in the InterTAN group was least, followed by the proximal femoral locking compression plate group. Intraoperative blood loss in the arthroplasty group was most; the difference was statistically significant (P < 0.05). The difference of hemoglobin before and after the operation was lower in the proximal femoral locking compression plate group than in the InterTAN group and arthroplasty group (P < 0.05). Postoperative bed rest time in the proximal femoral locking compression plate group was significantly longer than that in the InterTAN group and arthroplasty group (P < 0.05). (2) The total Harris score of the hip joint at 6 months in the arthroplasty group was highest, followed by the InterTAN group, and it was lowest in the proximal femoral locking compression plate group; significant differences were found among the three groups (P < 0.05). The total Harris score of the hip joint in the proximal femoral locking compression plate group at 12 months after operation was significant lower than that in the InterTAN group and arthroplasty group (P < 0.05). (3) The incidence of postoperative complications in the InterTAN group, proximal femoral locking compression plate group and replacement group were 21%, 34% and 21%, respectively, with no significant difference (P > 0.05). (4) It is concluded that compared with proximal femoral locking compression plate, InterTAN and cemented hemiarthroplasty in the treatment of senile cerebral infarction with hemiplegic intertrochanteric fracture have shorter postoperative bed rest time and better postoperative hip function recovery, which can be used as the preferred choice. However, cemented hemiarthroplasty has a faster recovery of hip function than InterTAN in the short term.

Key words: bone, hip, joint, fracture, steel plate, cerebral infarction, hemiplegia, femoral head, joint replacement

CLC Number:

Zhang Qingzhu, Wan Qian, Yin Xuelian, Hou Jing, Zhang Yi. Comparison of internal fixation and joint replacement for treating intertrochanteric fractures of cerebral infarction hemiplegia side in older adults[J]. Chinese Journal of Tissue Engineering Research, 2020, 24(36): 5818-5824.

Figures/Tables 9

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