经皮动力髋螺钉治疗股骨转子间骨折

Percutanceous dynamic hip screw for treatment of femoral intertrochanteric fractures

目的总结应用动力髋螺钉(DHS)经皮固定股骨转子间骨折的初步经验。方法自2003年5月应用DHS经皮固定股骨转子间骨折15例。其中男10例,女5例;年龄65～80岁,平均71岁。先将插入克氏针的瞄准器放在髋关节的前方,在C形臂监测下,使克氏针位于股骨头的中央,且瞄准器的股骨部分紧贴股骨的外缘。另将1枚导针经皮沿克氏针指示的方向打入股骨头。在导针下做一小切口,切口长2.8～3.5cm,拧入拉力螺钉。拔出导针将动力髋接骨板沿肌层插入,将导针穿过接骨板的套轴重新插入拉力螺钉内,并按常规方法将套轴套在螺钉的尾部。手术时间45～80min,平均55min。术中出血100～200ml,无一例需术中输血。结果2例伤口表浅感染,2例发生下肢深静脉血栓,但无肺栓塞发生。骨折术后3～4个月全部愈合,随访时间9～13个月,3例髋关节伸屈轻度受限,余皆正常。结论经皮DHS治疗股骨转子间骨折手术时间短,出血少,术后康复快,是一个很有前途的治疗方法。

Objective To evaluate the primary outcome of percutaneous dynamic hip screw （DHS） for femoral intertrochanteric fractures. Methods From May 2003 on, DHS using percutaneous technique was performed in 15 cases of femoral intertroehanteric fractures （ 10 males and five females） , with age range from 65 to 80 years （mean 71 years）. The procedure included following steps： the guide with K-wire was placed at the anterior part of the hip; then, the K-wire was placed in the center of the femoral head and finally the femoral plate portion of the guide was lined up with the lateral surface of the femur, A guide wire was inserted into the femoral head along the K-wire percutaneously, A small incision （2. 8-3.5 cm） was made along the guide wire for inserting a screw through into the femoral head, The guide wire was removed and the side plate slipped under the soft tissue. The guide wire was then reintroduced into the screw through the side plate barrel, followed by the side plate being seated on the screw, The operation time was 45-80 minutes （ average 55 minutes ）. The blood loss during the operation was 100-200 ml, No case needed blood transfusion, Results The superficial wound infection occurred in two cases, postoperative deep vein thrombosis without pulmonary embolism was seen in two and limited hip joint flexion in three, The following-up period averaged 12 months （9-13 months）. The period of bone union was 3-4 months. Conclusions Percutaneous DHS is a valuable treatment method for femoral intertroehanteric fractures, for it is characterized by less blood loss, shorter operation time and fast postoperative rehabilitation.