大转子顶点处不同开口对股骨近端防旋髓内钉治疗老年股骨转子间骨折临床疗效的影响OA

Objective To compare clinical efficacy of direct opening with a pointed cone and opening assisted by a honey-comb guide for proximal femoral nail anti-rotation(PFNA)in treating intertrochanteric fractures in elderly.Methods A retro-spective analysis was conducted on 76 elderly patients with intertrochanteric fractures of femur treated with PFNA from January 2019 to December 2023,including 34 males and 42 females,aged from 65 to 93 years old with an average of(73.82±4.98)years old.According to the different opening methods at the top of the large rotor,all patients were divided into direct opening group with pointed cone and opening group assisted by honeycomb guide.There were 35 patients direct opening group with pointed cone in pointed cone direct opening group,including 16 males and 19 females,aged from 65 to 91 years old with an average of(73.44±5.12)years old;a sharp cone was used to directly open apex of the greater trochanter,and fluoroscopy was adjusted to the best position after satisfactory fracture reduction.There were 41 patients in opening group assisted by honey-comb guide,including 18 males and 23 females,aged from 65 to 93 years old with an average of(74.15±4.84)years old;at the apex of the large rotor,the positioning needle was adjusted to the optimal position with the assistance of honeycomb guide be-fore opening.Operation time,fluoroscopy frequency,the occurrence of fracture re-displacement during the main screw insertion process,the quality of immediate fracture reduction after operation,fracture healing time,hip joint function at the final follow-up and the failure of internal fixation were compared between two groups.Results Seventy-six were successfully followed up from 12 to 18 months(14.5±2.3)months.No internal fixation failures such as withdrawal or cutting of helical blade and frac-ture of screw occurred in either group.The quality of fracture reduction in opening group assisted by honeycomb guide showed 28 patients with excellent and 13 with acceptable;in direct opening group with pointed cone,the quality was excellent in 13 patients and acceptable in 22 patients;there was statistically significant difference between two groups(P＜0.05).Harris hip score of opening group assisted by honeycomb guide was(85.64±7.91)points,which was better than that of direct opening group with pointed cone(82.06±7.52)points,and the difference was statistically significant(P＜0.05).There was 1 patient of re-displacement of opening group assisted by honeycomb guide,and 5 patients of re-displacement in direct opening group with pointed cone,there was a statistically significant difference between two groups(P＜0.05).Conclusion Both direct opening with a pointed cone and opening with the assistance of a honeycomb guide in treating intertrochanteric fractures of femur in el-derly patients with PFNA could achieve good therapeutic effects.Opening assited with a honeycomb guide is superior to direct opening with pointed cone in avoiding re-displacement of fracture during the process of opening and expanding bone marrow,improving the quality of immediate fracture reduction after operation,and restoring hip joint function.