Comparison of proximal femoral nail and dynamic hip screw for treating intertrochanteric fractures

摘要

Ama?: Bu ?al??mada Intertrokanterik kal?a k?r??? tedavisinde kullan?lan Proksimal femur ?ivisi ve dinamik kal?a vidas? cerrahi y?ntemleri mortalite ve morbidite a??s?ndan kar??la?t?r?ld?. Y?ntemler: Intertrokanterik k?r?k nedeniyle opere olan 131 hastan?n (72 kad?n, 59 erkek, ort ya? 77.85; da??l?m 65-98 y?l) demografik ?zellikleri ve ameliyat verileri de?erlendirildi. Doksan sekiz hastaya (%74,8) PFNA, otuz ü? hastaya ise (%25,2) DHS uygulanm??t?r. Hastalar?n ya?, cinsiyet, k?r?k olan kal?a taraf?, k?r?k etyolojisi, anestezi tipi, preoperatif bekleme süresi, anestezi hekimince hesaplanan preop ASA (American Society Anesthesiologists) skoru, Singh indeksi, takip süresi, k?r?k tipi, komplikasyon oran?, redüksiyon derecesi, tip-apeks mesafesi, k?sal?k varl??? ve kaynama düzeyi ve mortalite incelendi. Fonksiyonel de?erlendirmede Harris Kal?a Skoru kullan?ld?. Bulgular: Ameliyat sonras? ortalama takip süresi 25.23 (1-66) ay idi. Redüksiyon ba?ar?s? a??s?ndan DHS grubu lehine anlaml? fark saptanm??t?r (p0.05). DHS grubundaki hastalar?n Harris Kal?a Skorlar? istatistiksel olarak daha iyi bulundu (p0.05). Redüksiyon ba?ar?s? a??s?ndan DHS grubu lehine anlaml? ili?ki saptand? (p0.05). DHS grubunda redüksiyon ba?ar?s? ile Harris Kal?a Skoru do?ru orant?l? olacak ?ekilde anlaml? bulundu (p0.05). Sonu?: Preoperatif bekleme süresinin mortalite üzerine bir etkisinin olmad???na, ya? artt?k?a sistemik hastal?klar?n, dolay?s?yla da ASA skorlar?n?n artt???na ve ASA skorunun artmas?n?n da mortaliteyi artt?rd??? sonucuna var?ld?. ?nstabil intertrokanterik femur k?r?klar?nda PFNA, redüksiyon ba?ar?s? oranlar?n?n daha yüksek olmas? sebebiyle tercih edilmelidir. Ancak kaynama zaman? ve mortalite a??s?ndan belirgin bir fark saptanmad?. Hangi cerrahi y?ntemin kullan?laca??na hastan?n ya??na ve k?r?k tipine g?re kararla?t?r?lmas?n?n daha uygun olaca??na kanaat getirildi. Aim: In this study, the use of proximal femoral nail and dynamic hip screw for treatment of intertrochanteric hip fractures were compared in terms of mortality and morbidity. Methods: 131 patients who had an operation due to intertrochanteric hip fractures were evaluated demographic characteristics and surgical data (72 female, 59 male, mean age 77.85, range 65-98 years). 98 patients (74.8%) PFN method, 33 patients (25.2%) DHS method was applied. The age and gender of patients, etiology, type of anesthesia, preoperative waiting period, preoperative ASA (American Society Anesthesiologists) score calculated by anesthesia physicians, Singh index, track time, the type of fracture, complication rate, the degree of reduction, tip-apex distance, shortening the existence and mortality were investigated. The Harris Hip Score was used for functional assessment. Results: The average post-operative follow-up period was 25.23 (1-66) months. The group that were applied DHS were found significantly different for reduction success (p0.05). Harris Hip Scoring of patients in the DHS group were found significantly better (p0.05). The success of the reduction in the DHS group was significantly related with the Harris HipScore (p0.05). Conclusion: We have concluded that the preoperative waiting time has no impact on mortality, increasing age increases the systemic disease, therefore increases ASA score. So that increasing ASA score increases the mortality. Unstable intertrochanteric fractures of the femur PFNA, due to the higher success rate of reduction should be preferred. But between two methods there were no significant differences about healing time and mortality. In conclusion, surgical techniques to be used should be selected according to the fracture type and age of the patient.