加长版PFNA治疗股骨转子间骨折合并股骨干骨折的临床疗效研究

【摘要】 目的 研究重建钉和加长型PFNA用于股骨转子间骨折合并股骨干骨折治疗的临床疗效研究。方法 选取2012年1月~2014年6月到我院就诊并住院治疗的股骨转子间骨折合并骨干骨折的患者共60例为研究对象,分为两组: 为重建钉组和加长组,分别采用重建钉和加长型PFNA进行治疗,比较两组患者手术时间、术中出血量、骨折愈合时间、伤口长度、并发症、Harris评分、Lyshonlm评分。结果〓加长组的术中出血量、伤口长度均高于重建钉组(P<0.05),加长组的股骨转子间骨折的愈合时间和股骨干骨折的愈合时间也短于重建钉组(P<0.05),但两组手术时间差异无统计学意义。所有患者中只有一例发生切口感染,无其他严重并发症发生。加长组的Harris评分在术后各时间点均高于重建钉组,而Lyshonlm评分从术后第二个月开始之后的各时间点均低于重建钉组(P<0.05),但术后两周两组的Lyshonlm评分差异无统计学意义。结论 加长型PFNA用于股骨转子间骨折合并股骨干骨折治疗的临床疗效较好,患者恢复更快。     

Results of proximal femur nail antirotation for low velocity trochanteric fractures in elderly

Background:

The proximal femur nail antirotation (PFNA) is the recent addition to the growing list of intramedullary implants for trochanteric fracture fixation. The initial results in biomechanical and clinical studies have shown promise. We report our results of low velocity trochanteric fractures internally fixed by proximal femur nail antirotation.

Materials and Methods:

A prospective study was conducted to assess the results of 122 elderly patients with low velocity trochanteric fractures [39 – stable (AO; 31-A1) and 83 – unstable (AO; 31-A2 and A3)] treated with PFNA from December 2008 to April 2010. Followup functional and radiological assessments were done. Results obtained were compared between stable and unstable fracture patterns using statistical tools.

Results:

The mean followup was 21 months (12–28 months). 11 patients were lost in followup. Union was achieved in all but one patient. Varus collapse was seen in 14 patients and helical blade cut out in one patient. Stable and satisfactorily reduced fractures had a significantly better radiological outcome. Functional outcome measures were similar across fracture patterns. 65% of the patients returned to their preinjury status. The overall complication rate was also significantly higher in unstable fractures.

Conclusion:

Good results with relatively low complication rates can be achieved by PFNA in trochanteric fractures in the elderly. Attention to implant positioning, fracture reduction and a good learning curve is mandatory for successful outcomes.     

股骨近端防旋髓内钉和Gamma钉治疗老年不稳定型股骨转子间骨折疗效比较

目的比较股骨近端髓内钉和Gamma钉治疗老年不稳定股骨转子间骨折的疗效。方法将133例老年不稳定股骨转子间骨折患者按内固定方法分为股骨近端髓内钉(PFNA)组55例和Gamma钉组78例。比较两组的手术技巧、术后并发症、骨折愈合情况和髋关节功能。结果两组患者均获随访,时间6~18个月。两组在手术时间、术中出血量、骨折愈合情况及髋关节功能(末次随访Harris评分)比较差异均无统计学意义(P0.05)。Gamma钉组出现2例髋螺钉切割,1例远端锁钉断裂,1例股骨干骨折;PFNA组无相关并发症发生。结论 PFNA和Gamma钉均是治疗老年不稳定型股骨转子间骨折的理想方法。与Gamma钉相比,PFNA显著降低了术后并发症,更适用于治疗老年骨质疏松性不稳定型股骨转子间骨折。     

Bilateral intertrochanteric and femoral diaphyseal fractures with unilateral proximal tibial fracture: A case report and review of the literature

INTRODUCTION

Bilateral intertrochanteric femur fractures are relatively rare injuries. This study aims to present a case of a patient with simultaneous bilateral intertrochanteric femur fractures and femoral diaphyseal fractures and proximal tibial fracture with his twelve years follow-up.

PRESENTATION OF CASE

A 44-year-old man presented to emergency department after a motor vehicle accident. Bilateral intertrochanteric femur fractures (OTA classification – 31A.1.2) and bilateral femoral diaphyseal fractures (OTA classification – 32A.2) and nondisplaced right proximal tibial fracture (OTA classification – 41B.1) were determined in radiographs. Following closed reduction, fractures were fixed with intramedullary nails bilaterally. Proximal tibial fracture was fixed with cannulated screws following open reduction. At twelfth year follow-up he was able to do his daily activities with minimal limitation.

DISCUSSION

High energy traumas, stress fractures, systemic disorders (osteomalacia, chronic renal failure), steroid treatments, seizures and electric injuries are possible causes for bilateral hip factures. However bilateral femoral diaphyseal fractures are mostly due to high energy traumas. Long-term biphosphonate use may also cause bilateral fractures. Single-stage surgery should be performed in order to avoid secondary damages of surgical interventions. All fractures of our patient were fixed in a single session. This prevented further deterioration of patient''s status and made rehabilitation easy.

CONCLUSION

Careful evaluation of all systems should be performed in multi-trauma patients to find out concomitant injuries. Single staged surgical treatment may decrease morbidities.     

Comparison of cutout resistance of dynamic condylar screw and proximal femoral nail in reverse oblique trochanteric fractures: A biomechanical study

Background:

Reverse oblique trochanteric fracture of femur is a distinct fracture pattern. 95° Dynamic condylar screw (DCS) and proximal femoral nail (PFN) are currently the most commonly used implants for its fixation. This study aims to biomechanically compare the cutout resistance as well as modes of failure of DCS and PFN in reverse oblique trochanteric fractures.

Materials and Methods:

Sixteen freshly harvested cadaveric proximal femoral specimens were randomly assigned to three mean bone mineral density matched groups, eight of which were implanted with 95° DCS and the other eight with PFN. The constructs were made unstable to resemble a reverse oblique trochanteric fracture by removing a standard size posteromedial wedge. These constructs were subjected to computer controlled cyclic compressive loading with 200 kg at a frequency of 1 cycle/second (1 Hz) and end points of both the groups were analyzed.

Results:

The bending moment of the PFN group was approximately 50% less than that of the DCS group (P<0.0001). The PFN group resisted more number of cycles than the DCS group (P=0.03) and showed lesser number of component failures as compared with the DCS group (P=0.003).

Conclusions:

The PFN is biomechanically superior to DCS for the fixation of reverse oblique trochanteric fractures of femur.     

Long proximal femoral nail in ipsilateral fractures proximal femur and shaft of femur

Background:

Ipsilateral fractures of the proximal femur and femoral shaft are extremely uncommon injuries which occur in young adults who sustain a high energy trauma. A variety of management modalities have been tried to treat this complex fracture pattern ranging from conservative approach to recently introduced reconstruction nails. All these approaches have their own difficulties. We studied the outcome of long proximal femoral nail (LPFN) in the management of concomitant ipsilateral fracture of the proximal femur and femoral shaft.

Materials and Methods:

We analysed the prospective data of 36 consecutive patients who had sustained a high energy trauma (30 closed fractures and 6 open shaft fractures) who had concomitant ipsilateral fractures of the femoral shaft associated with proximal femur fractures treated with LPFN between December 2005 and December 2011. The mean age was 39 years (range 28-64 years). Twenty nine males and seven females were enrolled for this study.

Results:

The patients were followed up at three, six, twelve, and eighteen months. The mean healing time for the neck fractures was 4.8 months and for the shaft fractures was 6.2 months. The greater trochanter was splintered and widened in two cases which eventually consolidated. Two patients had superficial infection, two patients had lateral migration of the screws with coxa vara which was due to severe osteoporosis detected during the followup. We had two cases of nonunion of shaft fracture and one case of nonunion of neck fracture. Two cases of avascular necrosis of femoral head were detected after 2 years of followup. No cases of implant failure were noted. Limb shortening of less than 2 cms was noted in four of our patients. The functional assessment system of Friedman and Wyman was used for evaluating the results. In our series 59.9% (n = 23) were rated as good, 30.6% (n = 11) as fair, and 5.5% (n = 2) as poor.

Conclusion:

Long PFN is a reliable option for concomitant ipsilateral diaphyseal and proximal femur fractures.     

DHS和PFNA治疗老年骨质疏松性股骨转子间骨折的疗效分析

目的 比较DHS和PFNA治疗老年骨质疏松性股骨转子间骨折的疗效.方法 61例老年骨质疏松性股骨转子间骨折的患者,31例应用DHS治疗股骨转子间骨折,30例应用PFNA治疗股骨转子间骨折,并对结果进行分析对比.结果 经9～18个月随访,平均12.9个月.PFNA组较DHS组在手术时间、切口长度等方面均有优势;按照Harris髋关节评分标准术后PFNA组和DHS组相比较无明显差异;术后并发症对比PFNA组较DHS组少,而PFNA组易于发生术中股骨干骨折.结论 PFNA治疗老年骨质疏松性股骨转子间骨折具有创伤小、固定牢靠、抗旋转、抗切割等优点,是理想的内固定物.     

两种内固定治疗股骨转子间骨折的疗效比较

目的比较股骨近端防旋髓内钉(PFNA)与新一代髓内钉(InterTAN)治疗股骨转子间骨折的疗效。方法将96例股骨转子间骨折患者按照随机数字表法分为PFNA组和InterTAN组,各48例。比较两组手术时间、术中出血量、住院时间、骨折愈合时间、扶拐时间、术后6个月Harris髋关节评分以及术后并发症。结果患者均获得随访,时间6~18个月。手术时间、术中出血量、骨折愈合时间PFNA组均短(少)于InterTAN组(P<0.05)。住院时间、扶拐时间、术后6个月Harris髋关节评分两组比较差异均无统计学意义(P>0.05)。术后并发症发生率PFNA组低于InterTAN组(P<0.05)。结论PFNA与InterTAN内固定治疗股骨转子间骨折均具有良好治疗效果,但PFNA较InterTAN具有手术时间短、术中出血量少、并发症发生率低、骨折愈合时间短的优点。     

闭合复位防旋股骨近端髓内钉治疗股骨转子间骨折

目的探讨闭合复位旋股骨近端髓内钉（PFNA）治疗股骨转子间骨折的疗效。方法采用闭合复位PFNA治疗股骨转子间骨折58例,记录手术时间,术中出血量,观察骨折愈合情况。采用Harris评分评估髋关节功能情况。结果手术时间为45~88（55.2±8.9）min,术中出血量80~180（95.5±14.3）ml。54例获随访,时间6~24个月,骨折均骨性愈合;4例失访。Harris功能评分：优13例,良32例,中9例,优良率83.3%。结论闭合复位PFNA治疗股骨转子间骨折,创伤小,操作简便,出血少,固定牢固,并发症少,疗效满意。     

两种方法治疗老年股骨转子间骨折的疗效比较

目的比较防旋股骨近端髓内钉(PFNA)与股骨转子间顺行髓内钉(InterTAN)治疗老年股骨转子间骨折的临床疗效。方法将141例老年股骨转子间骨折患者根据内固定材料不同分为PFNA组(87例,采用PFNA治疗)和InterTAN组(54例,采用InterTAN治疗)。比较两组患者手术时间、术中出血量、术后输血例数、输血量、骨折愈合时间、内固定相关并发症发生例数、末次随访Harris评分等级、术后下肢深静脉血栓(DVT)发生率。结果手术时间PFNA组短于InterTAN组(P<0.05)。两组术中出血量、术后输血例数和输血量比较差异无统计学意义(P>0.05)。两组患者均获得随访,时间6~18个月。骨折均骨性愈合,骨折愈合时间PFNA组长于InterTAN组(P<0.05)。两组末次随访Harris评分等级、术后下肢DVT发生率及内固定相关并发症发生率比较差异无统计学意义(P>0.05)。结论PFNA与InterTAN均为治疗老年股骨转子间骨折的理想选择,PFNA手术时间更短,而InterTAN术后骨折愈合时间更短。     

Proximal femoral nails compared with reverse distal femoral locking plates in intertrochanteric fractures with a compromised lateral wall; a randomised controlled trial

Purpose

There is no consensus about the best option of internal fixation for unstable intertrochanteric fractures. The aim of the present study was to compare proximal femoral nail (PFN) with contralateral reverse distal femoral locking compression plate (reverse-DFLCP) in the management of unstable intertrochanteric fractures with compromised lateral wall.

Method

In a randomized controlled study, from November 2011 to October 2012, 40 patients with unstable intertrochanteric fractures with compromised lateral wall (AO 31A 2.2 to 3.3) had osteosynthesis by PFN (n = 20) or reverse-DFLCP (n = 20). Intra-operative variables compared were duration of surgery, blood loss during surgery, fluoroscopy time and surgeons perception of the surgery. Patients were followed up clinically for a minimum of one year. Functional outcome was assessed by Parker Palmer mobility score (PPMS), Harris hip score (HHS), and Short Form-12. Failure was defined as any condition which would necessitate revision surgery with change of implant.

Results

Duration of surgery (p = 0.022), blood loss during surgery (p = 0.008) and fluoroscopy time (p = 0.0001) were significantly less in the PFN group than in the reverse-DFLCP group. No significant difference was found in type of reduction, difficulty in reduction and surgeon’s perception of surgery. The PFN group had better functional outcome than the reverse-DFLCP group. HHS for the PFN group was 81.53 ± 13.21 and for the reverse-DFLCP group it was 68.43 ± 14.36 (p = 0.018). SF-12 physical (p = 0.002) and mental component (p = 0.007) scores in the PFN group was significantly better than in the reverse-DFLCP group. There was one failure in the PFN group as compared to six in the reverse-DFLCP group (p = 0.036).

Conclusion

Due to favourable intra-operative variables, better functional outcome and lower failure rates, we conclude that PFN is a better implant than reverse-DFLCP for intertrochanteric fractures with compromised lateral wall.Keyword: Unstable intertrochanteric fractures, Lateral wall, Proximal femoral nail, Reverse distal femoral locking compression plate     

PFNA治疗高龄骨质疏松性股骨粗隆间骨折体会

目的探讨股骨近端抗旋髓内钉(proximal fermoral nail anti-rotation,PFNA)在治疗高龄骨质疏松性股骨粗隆间骨折临床疗效。方法应用PFNA治疗36例75岁以上高龄骨质疏松性股骨粗隆间骨折患者,手术采用闭合复位,小切口置入PFNA内固定,同时注重围手术期处理及抗骨质疏松治疗。结果 36例获得随访,时间9～24个月,平均12个月。其中1例90岁患者,于术后9个月死于脑梗塞,其余35例骨折全部愈合,无感染、骨不连、髋内翻、内固定失效等并发症的发生。根据Harris功能评分标准:28例优,4例良,3例中,优良率91.4%。结论 PFNA对于高龄骨质疏松性股骨粗隆间骨折具有微创性,固定可靠,疗效满意等优点。     

防旋型股骨近端髓内钉与Gamma钉治疗老年股骨转子间骨折的疗效观察

目的比较防旋型股骨近端髓内钉（PFNA）与Gamm a钉治疗老年股骨转子间骨折的疗效。方法 99例老年股骨转子间骨折患者,53例使用PFNA固定,46例使用Gamm a钉固定,对两组手术时间、术中出血量、骨折愈合时间、并发症和髋关节功能等进行临床随访分析。结果平均手术时间和出血量PFNA组均少于Gamm a组,差异有统计学意义（P〈0.01）;骨折愈合时间两组比较差异无统计学意义（P〉0.05）;并发症发生率PFNA组低于Gamm a组,差异有统计学意义（P〈0.05）。PFNA组和Gamm a组优良率分别为90.57%和86.96%,差异无统计学意义（P〉0.05）。结论 PFNA设计合理,微创操作,出血少,固定可靠,是治疗老年股骨转子间骨折的理想方法之一,尤其适用于骨质疏松性股骨转子间骨折。     

防旋型股骨近端髓内钉治疗股骨转子间骨折的临床研究

[目的]探讨防旋型股骨近端髓内钉(proximal femoral nail antirotation,PFNA)治疗股骨转子间骨折的手术方式及临床疗效。[方法]统计2007～2009年,采用PFNA治疗42例股骨转子间骨折患者。按Evans-Jensen标准分型,准确记录每例患者的手术时间、股骨近端切口长度、术中失血量、术后并发症情况、术后下床部分负重时间及术后半年髋关节Harris功能评分后进行统计学分析。[结果]42例患者中的39例获得6～25个月的随访。4种骨折类型在手术时间、术中失血量、术后下床部分负重时间上相比差异具有统计学意义(P<0.05),表现为随骨折复杂程度的增加,手术难度亦逐渐加大,并且术后负重时间均相应延长。但在手术切口长度、术后并发症情况及术后Harris功能评分相比较差异无统计学意义(P>0.05)。术后半年按髋关节Harris功能评分:优13例,良18例,中6例,差2例,优良率为79.4%。[结论]PFNA治疗股骨转子间骨折固定可靠,初期临床疗效满意,但对于骨折类型复杂的转子间骨折,其操作具有一定难度,医源性创伤亦较大,行有限切开复位骨折并加以辅助性固定有利于预防术后髋内翻并发症的发生。     

两种髓内钉固定骨质疏松股骨粗隆间骨折的比较

[目的]比较股骨近端抗旋转髓内钉(proximal femoral nail anti-rotation,PFNA)与InterTAN髓内钉联合抗骨质疏松治疗骨质疏松性粗隆间骨折的临床疗效.[方法]回顾性分析2016年1月-2019年1月苏州大学第一附属医院骨科诊治的骨质疏松性股骨粗隆间骨折的老年患者的临床资料,共10...     

Intertrochanteric fractures in elderly high risk patients treated with Ender nails and compression screw

Background:

Ender and Simon Weidner popularized the concept of closed condylocephlic nailing for intertrochanteric fractures in 1970. The clinical experience of authors revealed that Ender nailing alone cannot provide secure fixation in elderly patients with osteoporosis. Hence we conducted a study to evaluate the efficacy of a combined fixation procedure using Ender nails and a cannulated compression screw for intertrochanteric fractures.

Materials and Methods:

76 patients with intertrochanteric fractures were treated using intramedullary Ender nails and cannulated compression screw from January 2004 to December 2007. The mean age of the patients was 80 years (range 70-105 years).Using the Evan’s system of classification 49 were stable and 27 unstable fractures. Inclusion criteria was high risk elderly patients (age > 70 years) with intertrochanteric fracture. The exclusion criteria included patients with pressure sores over the trochanteric region. Many patients had pre-existing co-morbidities like diabetes mellitus, hypertension, COPD, ischemic heart disease, CVA and coronary artery bypass surgery. The two Ender nails of 4.5mm each were passed across the fracture site into the proximal neck. This was reinforced with a 6.5 mm cannulated compression screw passed from the sub trochanteric region, across the fracture into the head.

Results:

The mean follow-up was 14 months (range 9-19 months) Average time to fracture union was 10 weeks (range 6-16 weeks). The mean knee ROM was 130° (± 5°). There was no case of nail penetration into hip joint. In five cases with advanced osteoporosis there was minimal migration of Ender nails distally.

Conclusions:

The Ender nailing combined with compression screw fixation in cases of intertrochanteric fractures in high risk elderly patients could achieve reliable fracture stability with minimal complications.     

股骨近端抗旋髓内钉在高龄骨质疏松性股骨转子间骨折中的应用

目的探讨股骨近端抗旋髓内钉（PFNA）在治疗高龄骨质疏松性股骨转子间骨折中的临床疗效。方法25例高龄骨质疏松性股骨转子间骨折患者均经牵引、闭合复位,术中不显露骨折区域,小切口置入PFNA内固定治疗。结果23例获得随访,时间13～24个月,其中1例94岁患者因尿毒症术后1年死亡。余22例X线片显示骨折均一期愈合,愈合时间为（8.2±3）个月。无感染、骨不连、内固定失效、螺旋刀片滑脱、再骨折及髋内翻等并发症发生。根据Harris功能评分评定疗效：优18例,良2例。结论PFNA治疗高龄骨质疏松性股骨转子间骨折的初期疗效满意,内固定可靠,允许早期功能锻炼。     

Mid-term outcomes after intramedullary fixation of peritrochanteric femoral fractures using the new proximal femoral nail antirotation (PFNA)

Background

Controversy persists concerning the preferred treatment of peritrochanteric femoral fractures. The purpose of the present study was to evaluate the mid-term outcomes of the newly developed implants - proximal femoral nail antirotation (PFNA) for the stabilisation of this type of fracture.

Methods

Between April 2006 and March 2008, 169 patients with peritrochanteric femoral fractures were treated with PFNA. As many as 26 patients were excluded from the study. According to the Orthopaedic Trauma Association (OTA) classification system, the remaining 143 fractures were classified as 19 cases of AO/OTA 31A1 fractures, 83 cases of 31A2 fractures, 28 cases of 31A3 fractures and 13 cases of 31A combined with proximal 32 fracture or separate proximal 32 fracture. The mean age of these patients was 67 years (range, 20-93 years). The operative time, the overall fluoroscopy time, the duration of hospitalisation and the surgical complications were noted. Patients were followed up for a mean of 21 months (range, 12-36 months). Functional outcomes were assessed according to the Harris hip scoring system.

Results

Fifteen patients (10%) required open reduction. The mean duration of surgery (from the beginning of close reduction to wound closure) was 72 min with a range between 45 and 170 min. The mean fluoroscopy time was 164 s with a range between 92 and 396 s. The mean time of hospital stay was 15 days. Postoperative X-rays showed a good or acceptable reduction in 134 cases (94%), and an ideal implant position in 131 cases (92%). There were 12 (8%) postoperative complications. All patients except one healed their fractures without any implant-specific complication (bending, breaking of the implant, cut out of the PFNA blade, femoral head penetration of the blade or ipsilateral fractures of the femoral shaft at the tip of the implant). The average time to bone healing was 16 weeks (range, 12-25 weeks). At the time of the latest follow-up, 106 patients (74%) were restored to their preoperative mobility. The mean Harris hip score was 84 points (range, 46-100 points). A total of 106 patients (74%) had an excellent or good outcome. According to the patients and/or their caregivers, outcome was described as satisfactory in 120(84%) of the 143 patients, and 36(90%) of the 40 patients, who were more than 80 years old.

Conclusion

The results suggest that PFNA is a very effective and safe method in the treatment of different patterns of peritrochanteric femoral fractures. The fixation is adequate to maintain reduction over time even in osteoporotic bones.     

Internal fixation of femoral neck fractures with posterior comminution: a biomechanical comparison of DHS® and Intertan nail®

Background and purpose

Internal fixation is a therapeutic mainstay for treatment of undisplaced femoral neck fractures and fractures without posterior comminution. The best treatment for unstable and comminuted fractures, however, remains controversial, especially in older patients. The present study was designed to assess the utility of the Intertan Nail® (IT) for stabilization of comminuted Pauwels type III fractures compared to dynamic hips screw (DHS).

Methods

Randomized on the basis of bone mineral density, 32 human femurs were assigned to four groups. Pauwels type III fractures were osteomized with a custom-made saw guide. In 16 specimens the posteromedial support was removed and all femurs were instrumented with an IT or a DHS. All constructs were tested with nondestructive axial loading to 700N, cyclical compression to 1,400N (10,000 cycles), and loading to failure. Outcome measures included number of survived cycles, mechanical stiffness, head displacement and load to failure.

Results

Postoperative mechanical stiffness and stiffness after cyclical loading were significantly reduced in all constructs regardless of the presence of a comminution defect (p = 0.02). Specimens stabilized with the IT had a lower construct displacement (IT, 8.5 ± 0.5 mm vs. DHS, 14.5 ± 2.2 mm; p = 0.007) and sustained higher failure loads (IT, 4929 ± 419 N vs. DHS, 3505 ± 453 N; p = 0.036) than the DHS constructs.

Interpretation

In comminuted Pauwels type III fractures, the fixation with the IT provided sufficient postoperative mechanical strength, comparable rate of femoral head displacement, and a similar tolerance of physiological loads compared to fractures without comminution. The absence of the posteromedial support in comminuted fractures tended to reduce the failure load regardless of the fixation method.     

股骨近端锁定解剖钢板和PFNA治疗老年股骨粗隆间粉碎性骨折的疗效比较

目的探讨股骨近端解剖锁定钢板（LCP）和股骨近端髓内钉一抗螺旋刀片（PFNA）治疗老年粗隆间骨折的临床疗效。方法将2009年1月至2012年12月收治的60岁以上的股骨粗隆间粉碎性骨折（EvansⅢ、Ⅳ型）患者共63例,平均年龄（78．7±7．8）岁,按照随机分组原则分为两组,LCD组患者采用股骨近端锁定解剖钢板固定,PFNA组采用PFNA固定。比较两组患者的平均手术时间、术中出血量、术后下地负重活动时间以及髋关节功能恢复情况。结果PFNA组手术时间、术中出血量、术后下地负重活动时间明显低于LCP组,Harris评分术后3个月差异有统计学意义（P〈0．05）,术后12个月差异无统计学意义（P〉0．05）。结论两种手术方法对于股骨粗隆间骨折均为有效的治疗措施,闭合复位PFNA内固定,手术简单,手术时间短,创伤小,骨折固定稳定,中远期疗效肯定,是较理想的治疗老年股骨粗隆间骨折的方法。