目的:比较微创内固定系统(less invasive stabilization system,LISS)倒置与防旋股骨近端髓内钉(proximal femoral nail antirotation,PFNA)治疗高龄复杂不稳定型股骨粗隆间骨折的近期疗效,探讨内固定选择的策略.方法:自2007年2月至2009年6月收治47例高龄复杂不稳定型股骨粗隆间骨折(EvansⅣ,Ⅴ,R型)的患者;23例应用LISS倒置治疗,男7例,女16例;年龄76～97岁;24例应用PFNA治疗,男9例.女15例,年龄73～90岁.并对两组手术时间、术中出血、术中摄片次数、切口长度、住院时间、骨愈合时间、髋关节功能情况进行分析对比.结果:所有患者获得随访,时间8～18个月,平均13.1个月.全部患者均获骨折愈合,无伤口感染、髋内翻及内固定切出等并发症.PFNA组较LISS倒置组在手术时间、切口长度等方面均略有优势,但无明显差异;按照Harris髋关节评分标准术后PFNA组和LISS倒置组相比较无明显差异.结论:PFNA及LISS倒置治疗高龄复杂不稳定型股骨粗隆间骨折近期疗效都比较理想,均为较好的内固定物.%Objective: To compare the therapeutic effectiveness of inverted less invasive stabilization system (LISS)and proximal femoral nail anlirotafion (PFNA)in treatment of complex unstable intertrochanteric fracture in aged, and to investigate the selective strategy of the internal fixation. Methods: From February 2007 to June 2009,47 senior patients with complex and unstable intertrochanteric fractures (Evans Ⅳ,Ⅴ, R-type) were treated. Among them 23 patients were treated by inverted LISS,including 7 males and 16 females,aged from 76 to 97 years;24 patients were treated by PFNA,including 9 males and 15 females,aged from 73 to 90 years old. The mean operating time,blood loss,intraoperative photographs frequency,incision length,length of stay, bone healing, hip function were analyzed and compared. Results: All patients were followed up for 8 to 18 months (averaged 13.1 months). All fractures got bone healing. No complications such as wound infection ,varus and internal fixation cut out occurred. The operative time,incision length ,in PFNA group had a slight ascendant than that in LISS inversion group,but there were no significant differences. According to postoperative Harris hip score outcome of LISS inversion group compared with the PFNA group, there was no significant difference. Conclusion: Both of PFNA and LISS have ideal effect in treatment of complex unstable intertrochanteric fracture in aged,and are good internal fixations.
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