PFNA和人工股骨头置换治疗老年股骨粗隆间骨折的疗效分析

目的探讨股骨近端防旋髓内钉（PFNA）和关节置换治疗老年人股骨粗隆间骨折的临床疗效。方法回顾性分析2005年10月～2009年6月收治的31例60岁以上老年不稳定型股骨粗隆间骨折患者进行PFNA和关节置换治疗的临床资料。其中接Evans分型，Ⅰ型7例，Ⅱ型11例，ⅢA型8例，ⅢB型3例，Ⅳ型2例。结果本组31例病人出院后均得到随访，随访时间为1～4年，平均15个月。全部患者均获得一期骨性愈合，愈合时间为3个月～8个月，平均时间为4．2个月。根据髋关节功能按Harris进行评定法，对两组髋关节功能进行评分。髋关节置换组91．8±6．1，PFNA治疗组96．3±8．1，两组的Harris评分差异无统计学意义俨〉0．05）。结论人工股骨头置换和PFNA治疗股骨粗隆间骨折优点突出，只要选择好适应证均能取得良好的效果。

Efficacy of PFNA and Artificial Femoral Head Replacement for Treatment of Senile Intertrochanteric Femoral Fractures

Objective To discuss the clinical efficacy of proximal femoral nail anti-rotation （PFNA） and joint replacement for treatmerit of senile intertrochanteric femoral fractures. Methods Retrospectively analyzing the clinical data of 31 cases of over 60 year-old patients with unstable intertrochanteric fractures fTom October 2005 to June 2009, who were treated with PFNA and joint replacement. Evans classification showed type I in 7 cases, type II in 11 cases, type IIIA in 8 cases, typel/IB in 3 cases, typelV in 2 cases. Results 31 patients were followed up after discharge, follow-up time was 1 to 4 years, with an average of 15 months. All patients received a first phase of bone healing, healing time was 3 months to 8 months, with an average of 4.2 months. According to Harris hip scores, the hip joint function scores of the two groups were assessed with total hip replacement group： 91.8 ± 6.1, PFNA treatment group： 96.3 ± 8.1. The Harris scores between the two groups had not statistically significant difference （P 〉0.05）. Conclusion Both artificial femoral head replacement and PFNA for the treatment ofintertrochantefic femoral fractures have obvious advantages, Which can achieve good results if choosing appropriate indicalions.