Objective To analye retrospectively the fixed fracture efficacy of intertrochanteric hip replacement and PFNA ( proximal femoral anti-rotation intramedullary nail) in the treatment of senior citizens with unstable intertrochanteric fractures and discuss its clinical significance. Methods From Jan. 2011 to Dec. 2013, 98 elderly patients with unstable intertrochanteric frac-tures were admitted. There were 52 cases PFNA internal fixation group (38 cases of typeⅢand 15 cases of type IV), and 46 ca-ses in hip replacement group (33 cases of typeⅢand 12 cases of type IV). Ooperative time, blood loss, blood transfusion, post-operative bed rest time, medical complications, postoperative Haris ratings were analysised after 1, 2, 8 and 16 weeks, with sta-tistical analysis. Results Compared with hip replacement surgery, the operative time, the blood loss and postoperative blood transfusion were less, and the bed rest time was short (P<0. 05) in PFNA group. The excellent rates after eight weeks and the former were better in the PFNA group than in hip replacement group, were better than the latter (P<0. 05). Conclusion The PFNA and hip replacement treatment of the unstable intertrochanteric fracture have their own characteristics. The PFNA is better than hip replacement, and clinically appropriate treatment choiceshould be individualized according to the patient's own condition.%目的 回顾性分析半髋关节置换术和PFNA(股骨近端抗旋转髓内钉)内固定治疗老年不稳定型粗隆间骨折疗效并讨论其临床意义. 方法 2011年1月至2013年12月收治老年不稳定型股骨粗隆间骨折患者98例,随机分为PFNA内固定组52例(Ⅲ型38例,Ⅳ型15例)及半髋关节置换术组46例(Ⅲ型33例,Ⅳ型12例). 观察指标包括手术时间,术中出血,术后输血,术后卧床时间,内科并发症等,术后1、2、8、16周Haris评分. 结果 与半髋关节置换术比较,PF-NA手术时间短、术中出血少、术后输血少、卧床时间短,差异有统计学意义(P<0. 05). 8周后临床优良率PFNA组优于半髋关节置换术组,差异有统计学意义(P<0. 05). 8、16周的Harris评分PFNA组优于半髋关节置换术组,差异有统计学意义(P<0. 05). 结论 PFNA和半髋关节置换术治疗高龄不稳定型粗隆间骨折各有其自身特点,PFNA优于半髋关节置换术,临床可根据患者自身病情个性化的选择合适的治疗方法.
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