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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."

[1] Haidukewych GJ . Intertrochanteric fractures: ten tips to improve results[J]. J Bone Joint Surg Am, 2009,91(3):712-719.
[2] Roberts KC, Brox WT, Jevsevar DS , et al. Management of hip fractures in the elderly[J]. J Am Acad Orthop Surg, 2015,23(2):131-137.
doi: 10.5435/JAAOS-D-14-00432
[3] Jensen JS . Classification of trochanteric fractures[J]. Acta Orthop Scand, 1980,51(5):803-810.
doi: 10.3109/17453678008990877
[4] 杨明, 张晓萌, 张培训 , 等. 经皮导入导针结合纯侧位透视简化股骨近端防旋髓内钉操作[J]. 北京大学学报(医学版), 2015,47(2):258-262.
doi: 10.3969/j.issn.1671-167X.2015.02.013
[5] Stern R, Lübbeke A, Suva D , et al. Prospective randomised study comparing screw versus helical blade in the treatment of low-energy trochanteric fractures[J]. Int Orthop, 2011,35(12):1855-1861.
doi: 10.1007/s00264-011-1232-8
[6] Harris WH . Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplast. An end-result study using a new method of result evaluation[J]. J Bone Joint Surg Am, 1969,51(4):737-755.
doi: 10.2106/00004623-196951040-00012
[7] Tucker A, Donnelly KJ, McDonald S , et al. The changing face of fractures of the hip in Northern Ireland: a 15-year review[J]. Bone Joint J, 2017,99B(9):1223-1231.
[8] 张树, 张继源, 杨杜明 , 等. 矢状位不稳定转子间骨折的形态特征和复位技术[J]. 北京大学学报(医学版), 2017,49(2):236-241.
[9] Chatterton BD, Moores TS, Ahmad S , et al. Cause of death and factors associated with early in-hospital mortality after hip fracture[J]. Bone Joint J, 2015,97B(2):246-251.
[10] Thaler HW, Gosch M, Kammerlander C . Orthogeriatrics: hip fracture and its implications[J]. Wien Med Wochenschr, 2013,163(19/20):433-434.
doi: 10.1007/s10354-013-0229-x
[11] Pedersen SJ, Borgbjerg FM, Schousboe B , et al. A comprehensive hip fracture program reduces complication rates and mortality[J]. J Am Geriatr Soc, 2008,56(10):1831-1838.
doi: 10.1111/jgs.2008.56.issue-10
[12] Evaniew N, Bhandari M . Cochrane in CORR®: intramedullary nails for extracapsular hip fractures in adults (review)[J]. Clin Orthop Relat Res, 2015,473(3):767-774.
doi: 10.1007/s11999-014-4123-7
[13] Shin YS, Chae JE, Kang TW , et al. Prospective randomized study comparing two cephalomedullary nails for elderly intertrochanteric fractures: Zimmer Natural nail versus proximal femoral femoral nail antirotation Ⅱ[J]. Injury, 2017,48(7):1550-1557.
doi: 10.1016/j.injury.2017.04.011
[14] 刘中邸, 徐海林, 陈建海 , 等. 解剖型股骨近端髓内钉治疗老年转子间骨折的初步疗效[J]. 中华老年骨科与康复电子杂志, 2017,3(5):265-269.
[15] Parmar DS, Porecha MM, Chudasama S . Long proximal femoral nails versus short proximal femoral nails for the management of proximal femoral fractures: a retrospective study of 124 patients[J]. Eur J Orthop Surg Traumatol, 2011,21(3):159-164.
doi: 10.1007/s00590-010-0683-8
[16] Chang SM, Song DL, Ma Z , et al. Mismatch of the short straight cephalomedullary nail (PFNA-Ⅱ) with the anterior bow of the femur in an Asian population[J]. J Orthop Trauma, 2014,28(1):17-22.
doi: 10.1097/BOT.0000000000000022
[17] 戴尅戎, 戴闵, 郭晓山 , 等. 中国骨科大手术静脉血栓栓塞症预防指南[J]. 中华骨科杂志, 2016,36(2):65-71.
doi: 10.3760/cma.j.issn.0253-2352.2016.02.001
[18] García-Fuster MJ, Fabia MJ, Furió E , et al. Should we look for silent pulmonary embolism in patients with deep venous thrombosis[J]. BMC Cardiovasc Disord, 2014,14(1):178.
doi: 10.1186/1471-2261-14-178
[19] Nosher JL, Patel A, Jagpal S , et al. Endovascular treatment of pulmonary embolism: selective review of available techniques[J]. World J Radiol, 2017,9(12):426-437.
doi: 10.4329/wjr.v9.i12.426
[20] Najafzadeh M, Kim SC, Patterson C , et al. Patients’ perception about risks and benefits of venous thromboembolism (VTE) after orthopedic surgery: a qualitative study[J]. BMC Musculoskelet Disord, 2015,16(1):1-8.
doi: 10.1186/s12891-015-0454-0
[21] Hou G, Zhou F, Tian Y , et al. Predicting the need for blood transfusions in elderly patients with pertrochanteric femoral fractures[J]. Injury, 2014,45(12):1932-1937.
doi: 10.1016/j.injury.2014.08.033
[22] 张培训, 薛峰, 安帅 , 等. 股骨近端防旋髓内钉和动力髋螺钉治疗股骨转子间骨折的显性和隐性失血量分析[J]. 北京大学学报(医学版), 2012,44(6):891-894.
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