动力髁螺钉在股骨转子周围骨折治疗中的应用

Application of dynamic condylar screw in treatment of intertrochanteric fractures of the femur

目的通过观察动力髁螺钉（DCS）在股骨转子周围骨折治疗中的应用和疗效，探讨DCS治疗股骨转子周围骨折的固定原理、可行性、优越性及相关注意事项。方法回顾性分析自2000年1月至2006年12月应用DCS治疗股骨转子周围骨折23例，其中老年患者10例，均有不同程度的内科并存症；青壮年13例，均系交通伤等高能量损伤。按Boyd分型：Ⅰ型1例，Ⅱ型5例，Ⅲ型9例，Ⅳ型8例。术前进行咩细体检及针对性治疗后，用DCS固定转子周围骨折。结果术后经平均18个月随访，尤死亡患者。早期并发症3例，其中肺部感染2例，泌尿系统感染1例，均经治疗痊愈。1例远期并发症，为创伤性关节炎。23例均达骨性愈合。按Harris评分标准，优良率达96％，无一例发生断钉、骨不连、髋内翻及下肢缩短外旋畸形等并发症。结论DCS治疗股骨转子周围骨折操作简单，符合生物力学特点，崮定牢固可靠，是治疗股骨转子间闻骨折的理想方法之一，尤其适用于转子下骨折、反转子骨折、骨折累及大转子梨状窝和转子下外侧皮质骨粉碎的骨折。

Objective To observe the application and efficacy of dynamic condylar screw （DCS） in treating intertrochanteric fractures of the femur and discuss the fixation principle, feasibility, advantages and related issues. Methods A retrospective analysis was done on 23 patients with intertrochanteric fractures of the femur treated with DCS from January 2000 to December 2006. Of all, there were 10 elderly patients with different levels of various kinds of internal diseases and 13 young patients injuried by high-energy such as traffic accidents. According to Boyd＇s classfication, there was one patient with type I fracture, five with type Ⅱ, nine with type Ⅲ and eight with type Ⅳ. After a detailed pre-operative physical examination and targeted treatment, DCS fixation was employed for intertrochanteric fractures of the femur. Results A follow-up for average 18 months showed no death. Early complications occurred in three patients including two with pulmonary infection and one with urinary tract infection, who got cured after proper treatment. There was one patient with long-term complication, post-traumatic arthritis.All 23 patients got bone healing, with excellence rate of 96% according to Harris criteria. There were no complications like breakage of nails, nonunion, coxa vara deformity, shortening or external rotation of the lower limb. Conclusions DCS has advantages of simple operation, reliable fixation and coincidence with biomechanical characteristics and hence is one of ideal methods for treatment of intertrochanteric fracture of the femur, especially for subtrochanteric fracture, contrary chanteric fractur, fracture involving large pyriform troehanteric and comminuted fractures of sub-trochanteric lateral os integumentale.