微创动力髋螺钉(DHS)治疗老年股骨转子间骨折

Treatment of the intertrochanteric fracture in aged patients with minitraumatic dynamic hip screws

目的微创置入动力髋螺钉(DHS)治疗老年股骨转子间骨折,以减少由于手术刺激引起的并发症和潜在疾病。方法1999年3月～2003年12月,我院应用微创方法置入DHS治疗96例(男70例,女26例)老年股骨转子间骨折。年龄60.1～87.2岁(平均76.4岁),受伤至手术时间3～10d(平均5.7d),均做充分的术前准备并对其疗效进行随访。结果96例患者获随访0.5～5.2年(平均3.2年),无死亡病例,旋转畸形2例,成角畸形4例,髋内外翻畸形4例,内固定失败2例,晚期髋内翻畸形2例,髋疼痛4例,无延迟愈合病例,并发症发生率为18.8%。愈合时间8～12周(平均8.9周),关节功能优80例,良10例,可4例,差2例,优良率为93.8%。结论微创DHS手术创伤小、卧床时间短、骨折愈合快、肢体功能恢复好、髋内翻等并发症少,是治疗老年股骨转子间骨折的理想方法。

Objective To report our treatment of intertrochanteric fractures in aged patients with minitraumatic dynamic hip screws, the purpose of which was to reduce complications resulting from the operative trauma. Methods From March 1999 to December 2003, 96 aged patients with intertrochanteric fracture (70 males and 26 females) were treated in our hospital. Their ages ranged from 60.1 to 87.2 years, averaging 76.4 years. Careful preoperative preparations of 3 to 10 days (averaging 5 days) were made. All of them were followed up. Results The follow ups lasted from 0.5 year to 5.2 years (averaging 3.2 years). No one died. Their complications included lower extremity rotatory deformity in 2 cases, angled deformity in 4, hip deformity in 4, fixation failure in 2, delayed varus deformity of hip in 2, and hip pain in 4. There was no delayed union. The complication rate was 18.8% , and union time 8 to 12 weeks (averaging 8.9 w). The excellent recovery rate was 93.8% . Conclusion Because of mild operative trauma, short time in bed, quick union, quick functional recovery, and limited complications, minitraumatic dynamic hip screws prove to be an ideal device to treat intertrochanteric fractures in aged patients.