股骨近端防旋髓内钉联合空心拉力螺钉治疗涉及外侧壁破裂的股骨转子间骨折

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Abstract Objective To review the results of proximal femoral nail antirotation (PFNA) combined with cannulate screw for reconstruction of lateral femoral wall in the treatment of intertrochanteric fracture.Methods The clinical data of 60 elderly patients with intertrochanteric fractures involved in lateral wall rupture from September 2017 to September 2019 were retrospectively analyzed.They were divided into group A (PFNA alone，30 cases) and group B (PFNA combined with cannulate screw reconstruction of lateral femoral wall，30 cases).There was no significant difference in general information such as gender，age，side，cause of injury，and time from injury to operation between the two groups (P＞0.05).The operation time，intraoperative blood loss，fracture healing time，postoperative complications，and tip apex distance (TAD) were compared between the two groups.The Harris hip score was used to evaluate the function 12 months after operation.Results The two groups were followed up for 9 to 16 months，with an average of 12 months.There was no significant difference in intraoperative blood loss and TAD at 2 months after operation in the two groups (P＞0.05).The operation time in group B was significantly longer than that in group A (t＝1.48，P＝0.045)；there were 5 complications (16.6%) occurred in group A after operation，including 1 case of main nail fracture，2 cases of displacement and nonunion (reoperation was performed again by artificial hip replacement)；2 patients with screw pull-out.There were 3 complications (10%)occurred in group B，including one case with fracture again in the intramedullary nail distal (reoperation was performed again by the full-length intramedullary nail).1 case with screw pull-out，and 1 case with ischemic necrosis of the femoral head (reoperation was performed again by artificial hip replacement)；there was no significant difference in the incidence of complications between the two groups (P＞0.05) .But，the fracture healing time in group A was significantly longer than that group B，showing significant difference(t＝2.064，P＝0.023).According to the Harris hip score at 12 months after operation，group B was significantly better than group A (t＝2.98，P＝0.01).Conclusion Compared with PFNA alone，the treatment of intertrochanteric fracture with PFNA combined with cannulate screw reconstruction of lateral femoral wall can significantly reduce postoperative complications，promote fracture healing，and quickly restore the daily life ability of patients.

Key words： intertrochanteric fracture proximal femoral nail antirotation lateral femoral wall cannulated screw

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