手术治疗股骨粗隆间骨折的常见并发症及对策

Complications of internal fixation for femoral intertrochanteric fracture and their treatment

目的探讨动力髋螺钉(DHS)、动力髁螺钉(DCS)和股骨近端髓内固定(Gamm a钉、PFN)治疗股骨粗隆间骨折术后并发症的原因及对策。方法总结1995年7月至2005年7月采用DHS、DCS和髓内固定系统23例股骨粗隆间骨折病例,对手术后并发症产生的原因进行了分析,并总结其治疗特点。结果23例患者的并发症种类包括:髋内翻、内固定物股骨头颈内切割、头颈螺钉位置异常、骨折不愈合、钢板螺钉松动等。结论内固定物选择不当、头颈螺钉位置错误是发生手术并发症的重要原因;不稳定骨折、重度骨质疏松、骨折复位不良、严重粉碎骨折骨缺损未一期植骨等都将增加手术并发症的发生率。

Objective To analyse the causes and treatment of postoperative complications of intertrochanteric fracture treated by DHS, DCS and intramedullary nail. Methods From July 1995 to July 2005, 23 cases of intertrochanteric fracture treated by DHS, DCS or intramedullary nail developed postoperative complications. We analysed the causes of the complications as well as the measures to treat these complications. Results The complications included coxa vara, cutting out of lag screw, incorrect position of lag screw, nonunion of fracture,loosening of plate and screws. Conclusion Unsuitable implant selection, incorrect position of lag screw are important factors responsible for postoperative complications. Unstable fracture, serious osteoporosis, unsatisfactory reduction, comminuted fracture and bone defect without bone graft will increase the incidence of complications.