目的·探究在接受防旋股骨近端髓内钉（proximal femoral nail antirotation，PFNA）手术治疗的骨质疏松性股骨转子间骨折高龄患者中，术后早期应用唑来膦酸对骨折愈合的影响，以及其他可能的相关因素。方法·回顾性分析2016年1月至2022年2月于上海交通大学医学院附属瑞金医院行PFNA手术的80岁及以上的股骨转子间骨折患者174例，根据术后是否早期接受唑来膦酸治疗将患者分为实验组（n=26）和对照组（n=148），所有患者完成术后6周和12周2次随访。运用倾向性评分匹配（propensity score matching，PSM）法将实验组与对照组患者按照1∶3的比例进行匹配，匹配因素包括年龄、性别、骨折分型以及体质量指数（body mass index，BMI）。比较2组患者匹配后的一般资料，以及2次随访时的骨折愈合和功能恢复情况。采用Logistic回归分析探究患者术后12周骨折愈合的相关因素。结果·PSM法匹配后得到实验组患者25例和对照组患者65例，2组患者一般资料间差异均无统计学意义。实验组患者术后6周和12周的骨折愈合率分别为16.0%和96.0%，均显著高于对照组（分别为1.5%和73.8%，均P<0.05）；实验组患者术后12周时Harris髋关节功能评分显著高于对照组（P=0.019）。Logistic回归分析结果显示，良好的手术复位（OR=12.52，95%CI 2.67~58.74，P=0.001）、术后早期使用唑来膦酸（OR=10.14，95%CI 1.01~102.09，P=0.049）和更高的血清白蛋白水平（OR=1.15，95%CI 1.02~1.29，P=0.025）为骨折愈合的促进因素，而不稳定型骨折（OR=0.10，95%CI 0.03~0.31，P=0.000）为不利因素。结论·对于接受PFNA手术的骨质疏松性股骨转子间骨折高龄患者，术后早期使用唑来膦酸可以促进骨折愈合且使患者获得更好的功能恢复；除此之外良好的术中复位、更高的血清白蛋白水平是促进骨折愈合的有利因素，而不稳定型骨折为骨折愈合的阻碍因素。

Objective ·To investigate the effect of early postoperative administration of zoledronic acid on fracture healing and functional recovery in elderly patients with osteoporotic femoral intertrochanteric fracture treated with proximal femoral nail antirotation (PFNA) surgery, and explore other potential prognostic factors. Methods ·A total of 174 patients with femoral intertrochanteric fractures of 80 years old or above who underwent PFNA treatment in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from January, 2016 to February, 2022, were divided into experimental group (n=26) and control group (n=148) according to whether they received zoledronic acid early after surgery. All patients were followed up twice at 6 weeks and 12 weeks after surgery. The patients in the experimental group were matched with the control group by propensity score matching (PSM) at a ratio of 1:3 (the matching factors included age, gender, fracture type, and body mass index). General characteristics, as well as fracture healing and functional recovery at the two follow-up visits were compared between the two groups after matching. Subsequently, Logistic regression was used to explore the potential prognostic factors on fracture healing at 12 weeks after surgery. Results ·PSM resulted in 25 patients in the experimental group and 65 patients in the control group, and there were no statistically significant differences in baseline characteristics between the two groups. The fracture healing rates at 6 weeks and 12 weeks after surgery in the experimental group (16.0% and 96.0%, respectively) were higher than those in the control group (1.5% and 73.8%), and the differences were statistically significant (P<0.05). Harris hip function score in the experimental group at 12 weeks was significantly higher than that of the control group (P=0.019). The results of Logistic regression analysis showed that good surgical reduction (OR=12.52, 95%CI 2.67?58.74, P=0.001), early postoperative administration of zoledronic acid (OR=10.14, 95%CI 1.01?102.09, P=0.049), and higher serum albumin level (OR=1.15, 95%CI 1.02?1.29, P=0.025) were the favorable factors of early fracture healing, while unstable fracture (OR=0.10, 95%CI 0.03?0.31, P=0.000) was the unfavorable factor. Conclusion ·For elderly patients with osteoporotic intertrochanteric femoral fractures treated with PFNA surgery, early postoperative administration of zoledronic acid can promote fracture healing and lead to better functional recovery; in addition, good surgical reduction and higher serum albumin levels are favorable factors for fracture healing, whereas unstable fracture presents as a hindrance to the healing process.