Objective To compare clinical outcomes of HA PFNA and DHS in treatment of intertrochanteric fracture in the elderly. Methods We compared the 68 patiends with intertrochanteric fracture who had been treated in our department. 23 cases of them were treated with HA,18 cases with PFNA and 27 cases with DHS. The three groups were compared in terms of operative time,intraoperative blood loss,fracture healing time ,Harris hip score and complication. Results Three groups were followed up for an average of 13. 3 months,the operative time was(45. 9 ± 9. 2)、(60. 5 ± 13. 8)、(92. 1 ± 33. 4)min,intraoperative blood loss was(465. 2 ± 39. 8)、(92. 1 ± 38. 5)、(327. 6 ± 44. 2)ml,fracture healing time was(16 ± 6)d、(1. 5 ± 0. 6)m、(1. 6 ± 0. 5)m,Harris hip score was(93. 2 ± 5. 6)、(85. 4 ± 8. 5)、(86. 7 ± 7. 4),there was significant difference between two group of them,there was no significant difference between PFNA and DHS group in healing time,complication rate was PFNA(5. 5% )and DHS(7. 4% ). Conclusion s Three threapy can be used to treat intertrochanteric fracture in the elderly,PFNA may have advantage for patients with serious osteoporosis,HA is good choice for patients in elderly with comminuted fractures.%目的：比较髋关节置换（HA）、动力髋螺钉（DHS）和股骨近端防旋髓内钉（PFNA）治疗老年股骨粗隆骨折的临床疗效。方法：对68例老年股骨粗隆骨折患者的资料进行分析，根据手术方式不同分为 HA 组、PFNA 组与 DHS 组，比较三组患者的住院时间、手术时间、术中出血量、术后引流量、骨折愈合时间、患髋功能 Harris 评分及并发症发生情况。结果：HA 组、PFNA 组、DHS 组患者均获随访，平均时间13.3个月，平均手术时间（45.9±9.2）min、（60.5±13.8）min、（92.1±33.4）min；术中出血量平均分别为（465.2±39.8）ml、（92.1±38.5）ml、（327.6±44.2）ml，愈合时间平均为（16±6）d、（1.5±0.6）个月、（1.6±0.5）个月，术后6个月 Harris 评分平均分别为（93.2±15.6）分、（88.4±14.5）分、（86.7±16.4）分，三组之间两两比较差异均有统计学意义（ P ﹤0.05），PFNA 组和 DHS 组之间的骨折愈合时间差异无统计学意义（ P ﹥0.05）。DHS 组出现髋内翻2例（7.4%），PFNA 组术后并发股骨干骨折1例（5.5%），HA 组无并发症发生。结论：三种手术治疗方式各有特点和优势，PFNA 适用于骨质疏松的不稳定型骨折和合并症较多的患者，但 HA 具有手术时间短、可早期下床活动等优点，更适用于高龄股骨粗隆粉碎性骨折的治疗。
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