DHS治疗股骨粗隆间骨折

Internal Fixation with DHS in Treatment of Femoral Intertrochanteric Fractures

目的探讨DHS内固定治疗股骨粗隆间骨折临床疗效。方法选择髋关节外侧切口,直视下复位,C形臂X线机监视下选择最佳髋螺钉进钉点后钻入导针,扩髓、攻丝,置放髋螺钉及钢板螺钉。本组50例,男37例,女13例;年龄21～89岁,平均60岁。结果50例随访时间3～22个月,平均8个月。复位及内固定满意率88.0%(44/50),愈合率为96.0%(48/50),功能恢复接近伤前水平为68%(34/50)。并发髋内翻为6.0%(3/50),其中2例为髋螺钉钉位不正、1例复位不良。骨不连为4.0%(2/50),均为反斜形粗隆间骨折,DHS固定失败螺钉折断后骨分离所致。1例髋螺钉钉位不正,经早期再手术换钉固定后骨折愈合。结论正确掌握DHS固定治疗股骨粗隆间骨折手术指征、规范手术操作及完善围手术期处理,是提高治疗效果的关键。

Objective To study therapeutic effect of internal fixation with dynamic hip screw(DHS) for treating femoral intertrochanteric fractures. Methods The hip lateral approach is made and reduction is performed. Properly selecting a location of inserted hip screw under fluorometry and drilling guide pins. Reaming, tapping and placing the system of DHS were formed in succession. 37 of 50 patients in the study were made and 13 were female. The ages ranged from 21 to 89 years and averaged 60 years. Results Follow-up of 50 cases was taken (3 to 22 months). The satisfied rate of reduction and internal fixation was 88.0% (44/50), bone healing was 96.0%(48/50) and recovery rate of functions on the whole was 68.0%(34/50). Surgical complications included coax vara rate was 6.0%(3/50), in whom 2 patients results from inaccurate placement of the screws and 1 was due to inadequate reduction; the bone nonunion rate was 4.0%(2/50) as 2 cases who were Boyd-Griffin Ⅲ style and sustained failure DHS fixation,resulted from fracture displacement because of screws breaking. Another undergone inoperative placement of hip screws and regained healing through a reoperation. Conclusion The key to acquire satisfied effects lies in taking operative indications in full consideration, standardizing manipunations and perfecting treatment of the perioperation.