目的:比较加长柄股骨头置换与股骨近端髓内钉(PFN)治疗高龄股骨粗隆间骨折的疗效。方法:选
取在我院行手术治疗的高龄股骨粗隆间骨折病人113 例作为研究对象，加长柄股骨头置换组( 置换组)58 例和
PFN 组55 例，对比分析2 组病人的临床疗效及并发症等相关指标。结果:PFN 组失血量为(201． 5 ± 38． 5)ml，住
院时间为(6． 8 ± 1． 9)d，置换组失血量为(863． 0 ± 87． 2)mL，住院时间为(16． 5 ± 4． 8) d，经t 检验，差异有统计学
意义，P ＜ 0． 05;PFN 组输血率为31． 0%，置换组为12． 7%，经χ2 检验，差异有统计学意义，P ＜ 0． 05;PFN 组末次
Harris 评分为(84． 6 ± 8． 5)分，置换组为(89． 5 ± 7． 2) 分，经t 检验，差异无统计学意义，P ＞ 0． 05;置换组优良率
为70． 7%，PFN 组优良率为78． 2%，经χ2 检验，差异无统计学意义，P ＞ 0． 05;置换组并发症总发生率为15． 5%，
PFN 组为7． 3%，经χ2 检验，差异有统计学意义，P ＜ 0． 05。结论:两种术式治疗高龄股骨粗隆间骨折的临床疗效
均较好，但PFN 内固定法术后并发症发生率低于置换组，较适合治疗高龄股骨粗隆间骨折。

Objective:To compare the effect of long － stem femoral head replacement and proximal
femoral intramedullary nail(PFN)for treatment of osteoporotic intertrochanteric fractures in elderly patients．
Methods:113 cases of intertrochanteric fractures in elderly patients treated in our hospital were
studied． 58 cases were treated with long － stem femoral head(replacement group)，while 55 cases were
treated with PFN(PFN group)． The two treatment groups were compared with regard to clinical curative
effect and complications． Results:In PFN group，blood loss was(201． 5 ± 38． 5)ml and hospital stay
was(6． 8 + 1． 9) d． In replacement group，blood loss was (863． 0 ± 87． 2) ml，and hospital stay was
(16． 5 ± 4． 8) d． There was significant difference between two groups by t － test ( P ＜ 0． 05)． Blood
transfusion rate in PFN group was 31%，while replacement group was 12． 7%． There was significant
difference by chi － square test ( P ＜ 0． 05)． In PFN group，the last Harris score was (84． 6 ± 8． 5)
points，while replacement group was (89． 5 ± 7． 2) points． There was no significant difference between
two groups( P ＞ 0． 05)． The excellent rate in PFN group and replacement group were 78． 2% and
70． 7%，respectively． The occurrence rate of complications were 7． 3% and 15． 5%，respectively． There
was significant difference between two groups(P ＜ 0． 05) by chi － square test． Conclusion:The treatment
of osteoporotic intertrochanteric fractures in elderly patients by long － stem femoral head replacement
and PFN are both good． But the incidence of complications of PFN fixation is lower than that of
replacement group． It is more suitable for treatment of senile intertrochanteric fracture．

R68

 收稿日期:2013 － 12 － 20;修回日期:2014 － 04 － 11
基金项目:陕西省卫生厅科研基金项目(2010B09)
作者简介:马建军(1964 － )，男，咸阳市第一人民医院骨二科副主任医师。