Objective To investigate the effects of proximal femoral anti-rotation intramedullary nailing on Harris score, functional recovery and prognosis of elderly patients with femoral intertrochanteric fracture. Methods A total of 120 elderly patients with femoral intertrochanteric fracture were divided into three groups according to the surgical methods: dynamic hip screw (DHS) group (n=40), proximal femoral locking plate (LPFP) group (n=40) and PFNAⅡgroup (n=40). Harris scores, weight bearing time, length of hospital stay and fracture healing time were observed and compared between two groups. Moreover, the mortality of patients at 30d,1 year after treatment was observed. Results There were no significant differences in Harris scores of typeⅠa among the three groups (P>0. 05). The Harris scores of typeⅠb,Ⅰc and typeⅠd in PFNAⅡgroup were significantly higher than those in DHS group and LPFP group (P<0. 05). The Harris scores of typeⅠc and typeⅠd in LPFP group were significantly higher than those in DHS group (P<0. 05). There were significant differences in Harris scores ofⅠa,Ⅰb,Ⅰc andⅠd between DHS group and LPFP group (P<0. 05). The Harris scores of typeⅠd in PFNAⅡgroup were significantly higher than those of typeⅠb, typeⅠc and typeⅠd (P<0. 05). The load bearing time and length of hospital stay of typeⅠa,Ⅰb,Ⅰc andⅠd in PFNAⅡgroup were significantly shorter than those in DHS group and LPFP group (P<0. 05). The fracture healing time of typeⅠc in PFNAⅡgroup was significantly shorter than that in DHS group,and the fracture healing time of typeⅠd was significantly shorter than that in DHS group and LPFP group (P<0. 05). The load bearing time, length of hospital stay and fracture healing time of typeⅠd in DHS group were significantly higher than those in type Ia and type Ib (P<0. 05). The hospital stay of typeⅠd in LPFP group was significantly higher than that in typeⅠa and type Ib (P<0. 05). The load bearing time of typeⅠc and typeⅠd in PFNAⅡgroup were significantly higher than those of typeⅠa, and that of typeⅠd was significantly higher than that of typeⅠc (P<0. 05). There were significant differences in the length of hospital stay of PFNAⅡgroup among typeⅠa, typeⅠb, typeⅠc and typeⅠd each other (P<0. 05). In addition, the mortality rates at 30d and a year after treatment in PFNAⅡgroup were significantly lower than those in DHS group and LPFP group (P<0. 05). Conclusion The proximal femoral anti-rotation intramedullary nailing is highly effective in treating femoral intertrochanteric fracture in elderly patients,which can not only significantly improve the function of hip joint, decrease load bearing time,length of hospital stay and fracture healing time, but also reduce the mortality rate of patients.%目的 研究股骨近端防旋髓内钉-Ⅱ治疗老年股骨转子间骨折对患者Harris评分、功能恢复影响,并对预后进行分析.方法 老年股骨转子间骨折患者120例,根据手术方法分为动力髋螺钉(DHS)组、股骨近端锁定钢板(LPFP)组和PFNA-Ⅱ组,每组40例.观察3组患者术后不同Evans分型Harris评分、下地负重时间、住院时间、骨折愈合时间,观察3组患者30 d、1年死亡情况.结果 3组术后Ⅰa型Harris评分比较差异无统计学意义(P>0.05).PFNA-Ⅱ组Ⅰb、Ⅰc、Ⅰd型Harris评分均高于DHS组和LPFP组(P<0.05).LPFP组Ⅰc、Ⅰd型Harris评分均高于DHS组(P<0.05).DHS组和LPFP组Ⅰa、Ⅰb、Ⅰc、Ⅰd型Harris评分,组内两两比较差异均有统计学意义(P<0.05).PFNA-Ⅱ组Ⅰd型Harris评分高于Ⅰb、Ⅰc、Ⅰd型(P<0.05).PFNA-Ⅱ组Ⅰa、Ⅰb、Ⅰc、Ⅰd型下地负重时间、住院时间均少于DHS组和LPFP组,差异有统计学意义(P<0.05).PFNA-Ⅱ组Ⅰc型骨折愈合时间少于DHS组,Ⅰd型骨折愈合时间少于DHS组和LPFP组(P<0.05).DHS组Ⅰd型下地负重时间、住院时间、骨折愈合时间均高于Ⅰa、Ⅰb组(P<0.05).LPFP组Ⅰd型住院时间高于Ⅰa、Ⅰb组(P<0.05).PFNA-Ⅱ组Ⅰc、Ⅰd型下地负重时间高于Ⅰa型,Ⅰd型高于Ⅰc型(P<0.05).PFNA-Ⅱ组Ⅰa、Ⅰb、Ⅰc、Ⅰd型住院时间两两比较(P<0.05).PFNA-Ⅱ组30 d、1年病死率均低于DHS组和LPFP组(P<0.05).结论 股骨近端防旋髓内钉-Ⅱ治疗不同类型老年股骨转子间骨折可以显著改善髋关节功能,减少患者下地负重时间、住院时间和骨折愈合时间,降低患者病死率.
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