摘要目的:探讨股骨近端通用髓内钉（proximal femoral universal nail，PFUN）治疗不稳定型股骨转子间骨折的早期临床疗效。方法:回顾性分析2022年1月至2024年6月于北京大学第三医院采用PFUN治疗随访完整的171例不稳定型股骨转子间骨折患者资料，男42例、女129例；年龄（80.8±8.2）岁（范围56~100岁），左侧96例、右侧75例。股骨转子间骨折171例，AO/OTA（2018版）31-A2型157例、A3型14例。美国麻醉医师协会分级，Ⅰ级2例、Ⅱ级130例、Ⅲ级39例。采用Baumgaertner和Kim影像学评价标准评价骨折复位质量，采用髋关节Harris评分系统评价髋关节功能。结果:171例患者均顺利完成手术，手术时间63（49.5，83）min，术中出血量50（50，100）ml。随访时间（16.1±2.7）个月（范围12~29个月）。术后根据Baumgaertner和Kim影像学标准评价，优115例、良50例、差6例，复位效果优良率达96.5%（165/171）。术后1、3、6个月及末次随访时髋关节Harris评分分别为（68.1±4.0）分、（76.7±4.1）分、（79.6±3.0）分、（88.8±2.8）分，差异有统计学意义（ F=2 439.145， P<0.001）；末次随访时髋关节Harris评分大于术后1、3、6个月，差异均有统计学意义（ P<0.05）。末次随访时髋关节Harris评分优96例、良70例、可4例、差1例，优良率为97.1%（166/171）。1例出现头颈螺钉切出而行内固定取出及髋关节置换术，内固定失效率为0.6%（1/171）。171例中，术后2例出现切口浅表感染（1.2%，2/171）、7例下肢深静脉血栓形成（4.1%，7/171）、2例肺炎（1.2%，2/171），并发症发生率为6.4%（11/171）。 结论:PFUN治疗不稳定型股骨转子间骨折能获得良好固定效果，早期临床疗效较好，内固定失效率低。

abstractsObjective:To explore the early clinical efficacy of the proximal femoral universal nail (PFUN) in the treatment of unstable intertrochanteric femoral fractures.Methods:A retrospective analysis was conducted on the data of 171 patients with unstable intertrochanteric femoral fractures who were treated with PFUN and followed up completely at Peking University Third Hospital from January 2022 to June 2024, including 42 males and 129 females. The age was 80.8±8.2 years, ranging from 56 to 100 years, with 96 cases on the left side and 75 cases on the right side. There were 157 cases of AO/OTA (2018 Edition) type 31-A2 and 14 cases of type 31-A3. According to the classification of the American Society of Anesthesiologists, there were 2 cases of grade I, 130 cases of grade II, and 39 cases of grade III. The quality of fracture reduction was evaluated by Baumgaertner and Kim imaging evaluation criteria, and the hip joint function was evaluated by the Harris scoring system of the hip joint.Results:All 171 patients successfully completed the operation. The operation time was 63 (49.5, 83) minutes and the intraoperative blood loss was 50 (50, 100) ml. The follow-up period was 16.1±2.7 months, ranging from 12 to 29 months. According to the Baumgaertner and Kim imaging criteria after the operation, 115 cases were excellent, 50 cases were good, and 6 cases were poor. The excellent and good rate of the reduction effect reached 96.5% (165/171). The Harris scores of the hip joint at 1, 3, 6 months after the operation and at the last follow-up were 68.1±4.0 points, 76.7±4.1 points, 79.6±3.0 points, and 88.8±2.8 points, respectively. The difference was statistically significant ( F=2 439.145, P<0.001). The Harris score of the hip joint at the last follow-up was higher than that at 1, 3, and 6 months after the operation, and the differences were statistically significant ( P<0.05). At the last follow-up, the Harris score of the hip joint was excellent in 96 cases, good in 70 cases, fair in 4 cases, and poor in 1 case. The excellent and good rate was 97.1% (166/171). One case had head and neck screws removed and underwent internal fixation removal and hip replacement surgery. The failure rate of internal fixation was 0.6% (1/171). Among the 171 cases, 2 cases had superficial incision infection (1.2%, 2/171), 7 cases had deep vein thrombosis of the lower extremities (4.1%, 7/171), and 2 cases had pneumonia (1.2%, 2/171) after the operation. The incidence of complications was 6.4% (11/171). Conclusion:Proximal femoral universal nail can achieve good fixation effects in the treatment of unstable intertrochanteric femoral fractures, with good early clinical efficacy and low failure rate of internal fixation.