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目的以第11版坎贝尔骨科手术学所述入路为对照，观察高龄患者转子间骨折改良入路的防旋股骨近端髓内钉( PFNA )的治疗效果。方法收集高龄股骨转子间骨折、经住院手术及随访4个月以上(平均6个月)的112例患者的资料，其中改良入路组治疗56例，传统入路组治疗56例，对切口长度、手术时间、术中失血量、输血比例、累积透视时间、住院时间及臀中肌步态、感染、髋内翻、髋关节活动受限及 CUT-OUT 等并发症及优良率等进行逐项总结和比较。结果改良入路组和传统入路组的平均切口长度[(2.13±0.31) cm vs.(5.09±1.97) cm ]、手术时间[(29.73±5.35) min vs.(39.21±4.33) min ]、术中失血量[(31.09±18.40) ml vs.(74.29±27.41) ml ]、累计透视时间[(20.05±2.50) s vs.(29.39±3.18) s ]、臀中肌步态(3例vs.6例)的差异有统计学意义( P＜0.05)，住院时间、骨折愈合时间的差异无统计学意义( P＞0.05)。采用改良入路组和传统入路组手术的术后6个月以上疗效评价，Harris评分优良率分别为94.64%和92.28%、感染、髋内翻、髋关节活动受限及CUT-OUT等其它并发症两者结果的差异无统计学意义( P＞0.05)。结论改良入路组治疗高龄股骨转子间骨折具有方法简单、切口长度短、累积透视时间短、手术时间短、手术出血量少、创伤小、隐性失血量小及术后输血比例低等优点，改良入路PFNA适合治疗高龄股骨转子间骨折。“,”Objective To observe the therapeutic effects of proximal femoral nail antirotation ( PFNA ) in the treatment of intertrochanteric fractures in the aged patients by an improved approach when compared with the traditional approach described in the 11th edition of Campbell’s Operative Orthopaedics. Methods The data of 112 aged patients with femoral intertrochanteric fractures, who were hospitalized and followed up for more than 4 months ( average: 6 months ) were collected. In the improved approach group 56 cases were treated, and there were 56 cases in the traditional treatment group. The incision length, operative time, intraoperative blood loss, blood transfusion ratio, cumulative fluoroscopy time, hospitalization time, gluteus medius gait, complications such as infection, coxa vara, limited hip movement and cut-out and excellent and good rates were summarized and compared item by item. Results The differences in average incision length [ ( 2.13 ± 0.31 ) cm vs. ( 5.09 ± 1.97 ) cm ], operative time [ ( 29.73 ± 5.35 ) min vs. ( 39.21 ± 4.33 ) min ], intraoperative blood loss [ ( 31.09 ± 18.40 ) ml vs. ( 74.29 ± 27.41 ) ml ], cumulative lfuoroscopy time [ ( 20.05 ± 2.50 ) s vs. ( 29.39 ± 3.18 ) s ] and gluteus medius gait ( 3 cases vs. 6 cases ) between the improved approach group and the traditional treatment group were statistically signiifcant ( P0.05 ). At 6 months after the operation, the therapeutic effects were evaluated in both the improved approach group and the traditional treatment group, and the Harris hip scores were 94.64%and 92.28%. The differences in infection, coxa vara, limited hip movement, cut-out and other complications between the 2 groups were not statistically signiifcant ( P > 0.05 ). Conclusions The improved approach for the treatment of senile femoral intertrochanteric fractures has the advantages of simple method, short incision length, short cumulative lfuoroscopy time, short operative time,less operative bleeding, small trauma, less hidden blood loss, lower blood transfusion ratio and so on. PFNA by the improved approach is suitable for the treatment of intertrochanteric fractures in aged patients.