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目的：探讨股骨粗隆间骨折 PFNA内固定术后髓内钉远端股骨骨折的治疗。方法2011年12月-2012年6月收治的股骨粗隆间骨折 PFNA内固定术后髓内钉远端股骨骨折3例患者，1例接受原内固定 PFNA取出更换加长 PFNA内固定手术，1例接受保留PFNA内固定，行骨折切开复位锁定钢板内固定取髂骨植骨术，1例接受保留 PFNA 内固定，行骨折切开复位锁定钢板加钢丝捆扎内固定手术。结果3例患者获得13～20个月（平均15．7个月）随访，未出现内固定材料断裂、弯曲、松动脱出。3例骨折已经骨性愈合。结论股骨粗隆间骨折 PFNA内固定术后髓内钉远端股骨骨折的治疗，我们对3例患者采用了3种手术方式治疗，体会是更换加长型 PF-NA创伤小，出血少，约150ml左右，手术时间短80分钟；而采用骨折切开复位锁定钢板固定手术，创伤大，出血多，约600ml-700ml左右，手术时间长150-160分钟。3种手术治疗方式骨折均骨性愈合，医师可以依据患者情况选择治疗方式。“,”Purpose Explore the operative procedures and clinical outcomes of treatment of femoral fractures at intramedullary nail distal after intertrochanteric fracture were fixed with PFNA .Method December 2011 to June 2012 ,3 patients had been treated .1 patient accepted fixating a-gain with longer PFNA .1 patient accepted continue to have the original internal fixation PFNA and fracture of femur were treated with open re-duction and locking plate fixation ,and bone were grafted using ilium .1 patients accepted to keep the original PFNA fixation and femoral fractures were treated with opened reduction and locking plate fixation and wire binding .Result 3 patients obtain follow -up for an average of 15 .7(range from 13 to 20)months ,It does not happen break or bending or loosening that within -fixed plate or screw or wire or intramedullary nail .3 case has obtain bony union .Conclusion Treatment for femoral fracture at distal of intramedullary nailing after Intertrochanteric fracture were fixed with PFNA ,3 patients were treated using three ways ,our experience is that :the replacement of the lengthened PFNA for treatment the fracture is minimally invasive ,less bleeding(about 150ml) ,a short time of operation .And the fracture were treated with open reduction and locking plate fixation ,there is more trauma ,much more bleeding(about 600 -700ml) ,and a long time of operation .