To analyze the difference in the effect of one-stage operation or staged operation for intertrochanteric fracture complicated with vertebral compression fracture.

The patients with intertrochanteric fracture complicated with vertebral compression fracture admitted to Hunan Brain Hospital from June 2018 to June 2020 were reviewed. Inclusion criteria: unilateral Evans Ⅰ-Ⅳ intertrochanteric fracture of the limb, proximal femoral anti-rotation intramedullary nail (PFNA) surgery within 24 h after injury, Ⅰ-Ⅱ degree compression fracture of the vertebral body. Exclusion criteria: previous hip fracture, spinal vertebral compression fracture within three months prior to injury, total or incomplete limb palsy prior to injury, vertebral burst fracture, pathological fracture, and compression fracture involving two or more vertebrae. According to the timing of spinal kyphoplasty (PKP), the patients were divided into two groups. One-stage operation group: PFNA and PKP were performed successively at the same stage; staged operation group: PFNA was performed first, and PKP was performed within three days after PFNA. Age, gender composition, visual analogue scale (VAS) score for preoperative back pain and functional independent score (FIM) score for elderly hip fracture were analyzed. Postoperative PFNA duration, PFNA intraoperative blood loss, postoperative six months FIM score, PKP duration, and VAS score for PKP postoperative back pain were analyzed. The length of hospitalization and total hospitalization cost were compared between the two groups. Chi-square test or Fisher′s exact test were used to compare the counting data such as gender ratio and previous diseases; t test was performed to analyze preoperative FIM score, time-consuming on PFNA procedure, six-month postoperative FIM score, and total cost of hospitalization; Mann-Whitney U test was used for comparison for the age, VAS scores of preoperative back pain, intraoperative blood loss of PFNA, the duration and VAS scores of postoperative back pain of PKP, and length of hospital stay.

A total of 67 patients were included in this study, including 39 patients in the primary surgery group and 28 patients in the staged surgery group. The age of patients in the two groups [69 (66, 74) years, 73 (67, 76) years, Z=1.601], the sex ratio ( χ²=2.975), preoperative back pain VAS scores [4 (2, 4), 4 (2, 4), Z=-0.728], preoperative FIM scores[ (61±5), (59±5), t=1.506] were basically the same. There was no significant difference (P>0.05). PFNA operation time (57.69±10.81) min, (62.54±12.69) min, t=-1.682), intraoperative PFNA blood loss [100.00(100.00, 150.00)ml, 100.00(50.00, 100.00)ml, Z=-1.076], FIM score six months after operation [(118.41±11.15), (114.89±10.48), t=1.306], there was no statistically significant difference between the patients and the staging operation group (P>0.05). The duration of PKP operation [20.00(15.00, 25.00)min, 20.00(15.00, 20.00)min, Z=-1.108] and the VAS score of back pain after PKP operation [0(0, 1.00), 0(0, 1.00), Z=-0.786] showed no statistically significant difference. The patients in the primary surgery group had shorter length of hospital stay [7.00 (6.00, 7.00) d, 11.00(9.50, 12.50) d, Z=-6.280] and lower total hospitalization cost [(4.90±0.21) ten thousand CNY, (5.16±0.25) ten thousand CNY, t=-4.486]. The differences were statistically significant (all P<0.05).

For patients with intertrochanteric fractures of femur combined with vertebral compression fractures, PFNA and PKP are similar in postoperative recovery and pain improvement by one-stage or staged operations, but the length of hospital stay and hospitalization cost can be reduced by staged operation.