Comparison of the effects of different surgical methods in the treatment of intertrochanteric fracture and analysis of death factors within 5 years after operation

Objective: To compare the clinical efficacy of proximal femoral locking compression plate(PFLCP),dynamic hip screw(DHS) and proximal femoral nail antirotation(PFNA) in the treatment of intertrochanteric fracture,and analyze the related factors of death within 5 years after surgery. Methods: A total of 146 patients with intertrochanteric fracture were divided into the PFLCP group(53 cases),DHS group(29 cases) and PFNA group(64 cases) according to different surgical methods.The total hospital stay,postoperative hospital day,operation time,intraoperative blood loss,intraoperative and postoperative blood transfusion volume,postoperative complications,first walking time,hip function score(Harris score) after 3 months and 1 year of surgery and mortality after 5 years of surgery were compared among three groups.The related factors of death within 5 years after operation were analyzed. Results: There was no statistical significance in the total hospital stay,postoperative hospital stay,Harris score after 1 year of surgery,mortality rate and loss of follow-up after 5 years of surgery among 3 groups(P>0.05).The differences of the operation time,intraoperative blood loss,intraoperative and postoperative blood transfusion volume,postoperative complications,first walking time and Harris score after 3 months of surgery among 3 groups were statistically significant(P<0.05 to P<0.01).The operative time and intraoperative blood loss in the PFNA group were lower than those in PFLCP group and DHS group(P<0.05).The incidence rates of postoperative complications in the PFNA and DHS groups were lower than that in PFLCP group(P<0.05).The intraoperative and postoperative blood transfusion volume in the PFNA and DHS groups were lower than that in PFLCP group(P<0.05).The first walking time of the PFNA and DHS groups were earlier than that of PFLCP group(P<0.05).The Harris scores of the PFNA and DHS groups were better than those of PFLCP group after 3 months of operation(P<0.05).The results of multivariate logistic regression analysis showed that the patient age,combined underlying diseases,total length of hospital stay and postoperative complications were correlated with death within 5 years after surgery(P<0.05 to P<0.01). Conclusions: PFNA,DHS and PFLCP can effectively treat intertrochanteric fracture,but the effect of PFNA is better than that of PFLCP and DHS.In addition to age,underlying disease and postoperative complications,the total length of hospital stay was also correlated with the risk of death within 5 years after operation.