Transition of treatments for fractures in Shanghai-Yunnan counterpart assisting hospitals

Abstract

Objective To analyze the changes in the treatments for femoral intertrochanteric fractures in Changning People's Hospital of Yunnan Province before and after Shanghai-Yunnan medical counterpart assistance to improve the medical service capacity of assisting hospitals. Methods A retrospective analysis was performed on the effects of two surgical methods for the treatment of intertrochanteric fractures that were implemented before and after technical improvement, respectively, from October 2012 to October 2017 at Changning People′s Hospital of Yunnan Province. According to the surgical method used, the patients were divided into either an anterior locking plate fixation group (plate group, n=17) or a proximal femoral nail antirotation (PFNA) group (n=25). The t-test and χ2 test were used to compare the operation time, intraoperative blood loss, time to initial weight-bearing, time to total weight-bearing, postoperative complications, hip Harris score at 1 year postoperatively, and hospital costs of the two groups. The operation time of the same doctor for PFNA was analyzed. Results The 42 patients were followed for 12 to 18 months with an average of 14.3 months. The average operation time, intraoperative blood loss, time to initial weight-bearing, time to total weight-bearing, hospitalization cost, and Harris score in the PFNA group were significantly less than those in the plate group [(86.80±28.97) min vs (156.76±31.70) min, (116.40±52.59) ml vs (273.53±113.85) ml, (12.50±3.72) d vs (20.19±5.98) d, (13.71±2.26) weeks vs (17.75±2.02) weeks, (14.40±1.94)×103 yuan vs (17.53±1.59)×103 yuan, (80.14±8.82) scores vs (91.05±4.89) scores; P<0.05]. The incidence of postoperative complications was lower in the PFNA group (4/25) than in the plate group (7/17), the difference was statistically significant (χ2=42.000, P<0.01). Conclusion Medical assistance can improve the therapeutic effects on intertrochanteric fractures and reduce the incidence of disability and poverty due to illness. Key words: Medical assistance; Intertrochanteric fractures; Treatment; Fracture fixation, intramedullary