老年不稳定性股骨粗隆间骨折动力髋治疗的疗效分析

Analysis on the effect of dynamic hip screw in treating unstable intertrochanteric fracture of the aged

目的:探讨动力髋螺钉(dynamichipscrew,DHS)内固定钢板治疗老年不稳定性股骨粗隆间骨折的临床疗效。方法:自1996年5月-2001年12月采用动力髋内固定治疗老年不稳定性股骨粗隆间骨折36例(EvansⅢA型20例,EvansⅢB型16例),男12例,女24例;年龄70～82岁,平均74岁。术中所有病例均在C形臂X线机透视下行135°DHS内固定,术后第3天起逐渐行股四头肌等长收缩锻炼,第4天起用CPM机行髋、膝、踝关节的被动活动。术后6周内避免髋关节主动内收及屈曲。结果:术后平均随访时间为1年。本组无感染、神经损伤、内固定物松动、脱位等并发症发生。1例EvansⅢB型发生轻度髋内翻。参照疗效标准对手术疗效进行评定:优26例,良9例,差1例,优良率97.2%。结论:DHS内固定是治疗老年不稳定性股骨粗隆间骨折的有效方法,失败率低。术前适当的皮牵引、术中尽可能恢复股骨粗隆后内侧皮质的完整性、标准的DHS固定位置及加强术后功能锻炼是取得良好效果的关键。

Objective:To explore the effect of dynamic hip screw (DHS) internal fixation in treating unstable intertrochanteric fracture of the aged.Methods:From May 1996 to December 2001,36 patients with unstable intertrochanteric fracture,among them,12 cases were males and 24 females,74 years old in average (range from 70 to 82 years),including fracture type EvansⅢA and EvansⅢB 20 cases and 16 cases respectively.All the patients were treated with 135° DHS fixation,meanwhile,C-arm X-ray machine was used to ensure good operation.The 3rd day after operation,to exercise isometric contraction of quadriceps femoris,and the 4th day after operation,to exercise hip,knee and ankle joint with CPM machine.Flextion and adduction of hip joint must be avoided before postoperative 6 weeks.Results:The mean following-up period was 1 year in all patients.Infection,injury of nerve,prosthetic loosening and dislocation have been not found after operation.Only one patient with type EvansⅢB remained less hip inversion.According to standard of effect:Excellent got 26 cases,good 9 cases,poor 1.Excellent and good percentage was 97.2%.Conclusion:DHS is an effective method with the lower failed rate for treatment of unstable intertrochanteric fracture of the aged.Reasonable skin traction before operation,possible recovery of inside-cortical integrity during operation,keeping of classic position of DHS fixation and increasing functional exercise after operation are the keys to obtain the satisfactorily result.