股骨粗隆间骨折DHS内固定失败相关因素分析

An analysis of the related factor of failed dynamic hip screw( DHS ) fixation in femoral intertrochanteric fractures

目的:通过对DHS失败病例结果的分析,得出一种单纯的影像学骨折分类方法,来预测术后并发症的发生,并阐述骨质疏松在粗隆间骨折治疗中的重要性。方法:采取回顾性总结的方法,收集1998年6月～2003年6月355例股骨粗隆间骨折动力髋螺钉(DHS)内固定病例,骨折按(Boyd Griffin,Evans,AO法)标准分类,骨质疏松按Singh标准分度,根据术后X线片评定复位的成败,即内翻角>100°,股骨头穿孔,螺钉穿出超过20mm或金属物断裂认定为手术失败。结果:总共发现97例失败病例,4例为稳定性骨折,93例为不稳定性骨折(Evans分类法),不稳定性骨折伴骨质疏松的病例手术失败率超过50%。结论:应用Singh和Evans分类法对术前股骨粗隆间骨折稳定性和股骨近端骨质疏松程度进行分类,可以精确地预测术后内固定的成败。对于Evans分类法属于不稳定的粗隆间骨折,并伴有Ⅲ级以上骨质疏松的病例,DHS不作为首选治疗方案,而应采用双极杯人工股骨头置换。

Objective:Through an analysis of the results of “failed dynamic hip screw( DHS )” cases,produce a reliable method of classification which ,using simple radiology,could both predict post-operative complications and also demonstrate the importance of osteoprosis in the treatment of the difficult fractures.Method:Using the methods of retrospective review,We have collected 355 cases of intertrochanteric fractures treated by DHS fixation between June 1998 and June 2003 and followed for a minimum of year. We used Singh's classification as a measure of osteoporosis and also classified the fractures according to Boyd-Griffin, Evans and AO system.The postoperative radiographs were examined for failure of reduction,varus angulation>100°, perforation of the femoral head, more than 20mm extrusion of a lag screw or metal failure.Result:We found 98 cases which showed radiographic failures.Four were stable fractures and 94 unstable fractures (Evans' classification).Unstable fractures with osteoporosis had a failure rate of more than 50%.Conclusion:The use of Singh′s classification and Evans' classification for femoral intertrochanteric fractures based on pre-operative X-ray allow for an accurate prediction of post-operative failure of fixation,for an unstable intertrochanteric fractures combined with osteoprosis(Singh's index above Ⅲ),treatment with a bipolar hemiarthroplasty should be preferred to DHS.