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Journal of Peking University(Health Sciences) ›› 2019, Vol. 51 ›› Issue (2): 283-287. doi: 10.19723/j.issn.1671-167X.2019.02.016

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Comparison of the effects of two cephalomedullary nails (zimmer natural nail and proximal femoral nail antirotation) in treatment of elderly intertrochan teric fractures

Jian CHEN1,Cai-hong ZUO1,Cai-yi ZHANG1,Ming YANG2,Pei-xun ZHANG2,∆()   

  1. 1. Department of Orthopaedics, People’s Hospital of Xuancheng City, Xuancheng 242000, Anhui, China;
    2. Department of Traumatology and Orthopaedics, Peking University People’s Hospital, Beijing 100044, China;
  • Received:2018-04-20 Online:2019-04-18 Published:2019-04-26
  • Contact: Pei-xun ZHANG E-mail:zhangpeixun@bjmu.edu.cn

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Abstract:

Objective: To explore the effect of cephalomedullary nails for elderly intertrochanteric fractures: proximal femoral nail antirotation (PFNA) versus zimmer natural nail (ZNN) to provide the data support for clinical perioperative management.Methods: A retrospective study was used to analyze the clinical data of elderly intertrochanteric fractures cases which were treated with PFNA or ZNN fixation from May 2016 to May 2017. In the study, 59 cases were followed up completely, in which 28 cases accepted PFNA, and the other 31 cases accepted ZNN. The operation time, amount of bleeding, fracture healing time, postoperative complication, postoperative radiographic measurement (tip apex distance, TAD) and the last follow-up of hip function score were analyzed.Results: The patients were followed up for 6 to 19 months, with an average (10.8±4.0) months. In PFNA group, the operation time was (62.7±14.2) min, the amount of bleeding was (56.8±20.6) mL, the fracture healing time was (4.6±0.8) months, the postoperative complication was 3.6%, the TAD was (17.7±5.5) mm, and the last follow-up hip function score was 91.8±3.6. In ZNN group, the operation time was (73.6±18.3) min, the amount of bleeding was (68.7±31.6) mL, the fracture healing time was (4.5±0.7) months, the postoperative complication was 3.2%, the TAD was (16.5±4.7) mm, and the last follow-up hip function score was 92.2±3.8. The two groups of comparative experiments were carried out, the operation time of the PFNA group was less than that of the ZNN group (P<0.05). There was no significant difference in the amount of bleeding, fracture healing time, postoperative complication, TAD, postoperative hip score between the two groups (P>0.05).Conclusion: Although group ZNN had significant longer operation time than group PFNA, both implants were useful tools in the treatment of elderly intertrochanteric fractures. The operation of PFNA was simpler,while the design of the anterior bow of ZNN might be more suitable for the patients with a large femoral anterior bow.

Key words: Femoral intertrochanteric fractures, Fracture fixation, Intramedullary nail, The elderly

CLC Number: 

  • R683

Table 1

Clinical data of patients"

Items PFNA (n=28) ZNN (n=31) P
Average age/years 81.9±7.1 79.0±6.7 0.113
Male/female 8/20 11/20 0.570
Right/left 16/12 13/18 0.243
Time from admission to operation/d 4.6±2.1 4.5±2.0 0.770
Classification of fracture, Ⅰ/Ⅱ/Ⅲ 12/15/1 15/15/1 0.913

Table 2

Surgery treatment results"

Items PFNA (n=28) ZNN (n=31) P
Operation time/min 62.7±14.2 73.6±18.3 0.014
Amount of bleeding/mL 56.8±20.6 68.7±31.6 0.089
Fracture healing time/months 4.6±0.8 4.5±0.7 0.545
Postoperative complications, n(%) 1 (3.6) 1 (3.2) 1
TAD /mm 17.7±5.5 16.5±4.7 0.081
Hip Harris score 91.8±3.6 92.2±3.8 0.700

Figure 1

Case 1, 77-year-old female with left intertrochanteric fracture (Evans-Jensen type Ⅲ) was treated with PFNA internal fixation A and B, preoperative 3D CT showed left intertrochanteric fracture(anteroposterior view and lateral view); C and D, postoperative radiographs(anteroposterior view and lateral view)."

Figure 2

Case 2, 87-year-old female with left intertrochanteric fracture (Evans-Jensen type ⅠB) was treated with ZNN internal fixation A and B, preoperative radiographs showed left intertrochanteric fracture(anteroposterior view and lateral view); C and D, postoperative radiographs(anteroposterior view and lateral view); E and F, postoperative pulmonary artery CTA showed occlusion of the bilateral pulmonary artery and significant in right side; G and H, pulmonary artery CTA showed that the range of bilateral pulmonary artery embolization was obviously reduced after 2 months anticoagulation."

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