Objective To investigate the effects of closed reduction proximal femoral nail antirotation (PFNA) internal fixation on the fracture healing and life quality of patients with femoral trochanteric fracture.Methods A total of 200 patients with femoral trochanteric fracture who were admitted and treated in our hospital from December 2010 to December 2016 were randomly divided into closed reduction group (n =100) and open reduction group (n =100).All the patients were treated by PFNA internal fixation,in addition,the patients in open reduction group were treated by open reduction,however,the patients in closed reduction group were treated by closed reduction,in which,according to closed reduction methods,the patients were redivided into traditional closed reduction group and improved closed reduction group,with 50 patients in each group.The patients in traditional closed reduction group were treated by traditional manual traction closed reduction,however,the patients in improved closed reduction group were treated by improved minimally invasive prying closed reduction.After treatment,the hip joint function of patients was assessed by Harris hip function criteria (Harris),and patient's life quality was evaluated by daily life ability scale (ADL),with 12-month followe up.The curative effects,intraoperative bleeding volume,weight-bearing functional exercise,length of staying in hospitalization,fracture healing time,complications and Hip joint function before and after treatment,the life quality before treatment and on 3m,12m after treatment were statistically analyzed.Results The intraoperative bleeding volume,length of staying in hospital,incidence rates of traumatic complications in traditional closed reduction group and improved closed reduction group were significantly lower than those in open reduction group (P ＜ O.05),however,there were no significant differences in these indexes between traditional closed reduction group and improved closed reduction group (P ＞ 0.05).The weight-bearing functional exercise,fracture healing time,incidence rates of healing complications in open reduction group and improved closed reduction group were significantly lower than those in traditional closed reduction group (P ＜ 0.05),but there were no significant differences in these indexes between open reduction group and improved closed reduction group (P ＞ 0.05).Moreover there were no significant differences in the excellent and good rates of therapeutic effects after 3-month treatmen,ADL scores and Harris scores among open reduction group,traditional closed reduction group,improved closed reduction group (P ＞ 0.05),however,the the excellent and good rates of therapeutic effects after treatmen,ADL scores and Harris scores after 12-month treatmen in open reduction group and improved closed reduction group were significantly higher than those in traditional closed reduction group (P ＜ 0.05),furthermore,there were no significant differences in the excellent and good rates of therapeutic effects after 12-month treatmen,ADL scores and Harris scores between open reduction group and improved closed reduction group (P ＞ 0.05).Conclusion The closed reduction PFNA internal fixation in treatment of femoral trochanteric fracture can effectively decrease intraoperative trauma and incidence of traumatic complications,without adverse effects on short-term curative effects and life quality of patients,but traditional manual traction closed reduction may decrease fracture healing effects,long-term curative effects and life quality,however,the improved minimally invasive prying closed reduction can effectively avoid these shortcomings,therefor,which is worth using widely in clinical practice.%目的 探讨闭合复位防旋髓内钉(PFNA)内固定术治疗对股骨粗隆骨折患者骨折愈合和生活质量的影响.方法 选取确诊治疗的股骨粗隆骨折患者200例,依据随机数字表法随机分为闭合复位组和切开复位组,每组100例.所有患者给予PFNA内固定术治疗,切开复位组患者术中给予闭合复位治疗,闭合复位组患者术中给予闭合复位治疗,其中依据闭合复位方法分为传统闭合组和改良闭合组,每组50例,传统闭合组患者给予传统手法牵引闭合复位治疗,改良闭合组患者给予改良微创撬拨闭合复位治疗,采用Harris髋关节功能评分标准(Harris)评估髋关节功能,采用日常生活能力量表(ADL)评估生活质量,随访12个月,分析患者治疗疗效、术中出血量、负重功能锻炼、住院、骨折愈合时间、并发症发生情况和治疗前后髋关节功能、治疗前、治疗后3、12个月的生活质量情况.结果 传统闭合组和改良闭合组患者术中出血量、住院时间、创伤性并发症发生率明显低于切开复位组,差异有统计学意义(P＜0.05),但传统闭合组和改良闭合组患者上述指标水平基本相同,差异无统计学意义(P＞0.05);切开复位组和改良闭合组患者负重功能锻炼、骨折愈合时间、愈合性并发症发生率明显低于传统闭合组,差异有统计学意义(P＜0.05),但切开复位组和改良闭合组患者上述指标水平基本相同,差异无统计学意义(P＞0.05);切开复位组、传统闭合组和改良闭合组患者治疗后3个月的治疗优良率、ADL得分和Harris得分基本相同,差异无统计学意义(P＞0.05),但切开复位组和改良闭合组患者治疗后治疗优良率、治疗后12个月的ADL得分和Harris得分明显高于传统闭合组,差异有统计学意义(P＜0.05),且切开复位组和改良闭合组患者治疗后12个月的治疗优良率、ADL得分和Harris得分基本相同,差异无统计学意义(P＞0.05).结论 闭合复位PFNA内固定术治疗可有效减少股骨粗隆骨折患者术中创伤及创伤性并发症的发生,及对患者近期疗效、生活质量无不良影响,但传统手法牵引闭合复位治疗会降低患者的骨折愈合效果、远期疗效和生活质量,而通过改良微创撬拨闭合复位治疗,可有效避免传统手法牵引闭合复位治疗中的不足,值得临床作进一步推广.
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