Objective To analyze the effect of intramedullary fixation system on femoral intertrochanteric fracture in the elderly.Methods Proximal femoral nail anti-rotation (PFNA),proximal femoral nail (PFN),pressure interlocking intramedullary nail (InterTan) and Asian PFNA(PFNA-Ⅱ) four intramedullary fixation system were used to treat 95 elderly patients with femoral fractures.The operation time,intraoperative blood volume,number of fluoroscopy,fracture healing time and the final follow-up of Harris scores were compared among four methods.Results All 95 cases were followed up for 7 ～ 20 months.Fracture healing time was 6 ～ 9 months.The femoral neck fracture occurred in 1 case of PFNA group at 5 months after the operation.1 case of postoperative 3 months spiral blade cut out in PFNA-Ⅱ group;deep venous thrombosis occurred in 2 cases of the PFN group at 1 week after operation.Operation time:PFN group was longer than other three groups,compared with PFNA group and PFNA-Ⅱ group,the difference was statistically significant (P ＜ 0.05).there was no statistically significant difference compared with InterTan group (P ＞ 0.05);lnterTan group was compared with PFNA group and PFNA-Ⅱ group,the differences were statistically significant (P ＜0.05).PFNA group was compared with PFNA-Ⅱ group,the difference was statistically significant (P ＜ 0.05).Intraoperative blood loss:PFN group was more than the other three groups,compared with PFNA group and PFNA-Ⅱ group,the differences were statistically significant (P ＜ 0.05),there was no statistically significant difference compared with InterTan group (P ＞ 0.05);InterTan group was compared with PFNA group and PFNA-Ⅱ group,the differences were statistically significant (P ＜ 0.05),PFNA group had no statistically significant difference compared with PFNA-Ⅱ group (P ＞ 0.05).Machine C-arm fluoroscopy times:PFN group was more than the other three groups,compared with PFNA group and PFNA-Ⅱ group,the differences were statistically significant (P ＜ 0.05),there was no statistically significant difference compared with InterTan group (P ＞0.05);InterTan group was compared with PFNA group and PFNA-Ⅱ group,the differences were statistically significant (P ＜ 0.05);PFNA group had no statistically significant difference compared with PFNA-Ⅱ group (P ＞ 0.05).There were not statistically significant difference among the four groups of fracture healing time and the last follow-up of Harris scores (P ＞ 0.05).Conclusions Femoral intertrochanteric fractures should be treated with proper methods as intramedullary fixation system which can obtain good curative effect,and PFNA-Ⅱ and PFNA are less trauma.%目的 分析髓内固定系统对老年股骨转子间骨折的疗效.方法 采用股骨近端抗旋髓内钉(PFNA)、股骨近端髓内钉(PFN)、联合加压交锁髓内钉(InterTan)及亚洲型股骨近端抗旋髓内钉(PFNA-Ⅱ)4种髓内固定系统治疗95例老年股骨转子间骨折患者.比较4种方法的手术时间、术中出血量、透视次数、骨折愈合时间及末次随访Harris评分.结果 95例均获得随访,时间7～20个月.骨折愈合时间6～9个月.PFNA组1例术后5个月发生外伤后股骨颈骨折;PFNA-Ⅱ组1例术后3个月发生螺旋刀片切出;PFN组2例术后1同时发生深静脉血栓.手术时间:PFN组长于其他3组,与PFNA组、PFNA-Ⅱ组比较差异有统计学意义(P＜0.05),与InterTan组比较差异无统计学意义(P＞0.05);InterTan组与PFNA组、PFNA-Ⅱ组比较差异有统计学意义(P ＜0.05);PFNA组与PFNA-Ⅱ组比较差异有统计学意义(P＜0.05).术中出血量:PFN组多于其他3组,与PFNA组、PFNA-Ⅱ组比较差异有统计学意义(P＜0.05),与InterTan组比较差异无统计学意义(P＞0.05);InterTan组与PFNA组、PFNA-Ⅱ组比较差异有统计学意义(P＜0.05);PFNA组与PFNA-Ⅱ组比较差异无统计学意义(P＞0.05).C臂机透视次数:PFN组多于其他3组,与PFNA组、PFNA-Ⅱ组比较差异有统计学意义(P＜0.05),与InterTan组比较差异无统计学意义(P＞0.05);InterTan组与PFNA组、PFNA-Ⅱ组比较差异有统计学意义(P＜0.05);PFNA组与PFNA-Ⅱ组比较差异无统计学意义(P＞0.05).4组骨折愈合时间和末次随访Harris评分比较差异无统计学意义(P＞0.05).结论 股骨转子间骨折选择合适的髓内固定系统治疗都可以获得良好疗效,而PFNA-Ⅱ和PFNA损伤更小.
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