动力髋加压螺钉治疗老年股骨粗隆骨折失败原因分析

An analysis of the cause of failed dynamic hip screw(DHA)fixation in faemoral intertrochanteric farctures

目的探讨动力髋加压螺钉(dynamichipscrew,DHS)治疗股骨粗隆间骨折失败的原因,并提出相应的防治措施。方法采用回顾性总结的方法,收集2003年7月至2008年6月86例老年股骨粗隆骨折动力髋螺钉(DHS)内固定病例,骨折按Evans标准分类,根据术后X线片评定复位的成败,内翻角>100°,股骨头穿孔,螺钉穿出超过20mm或金属物断裂认定为手术失败。结果 86例均得到随访,平均随访时间为37.5个月,6例患者出现失误或并发症,发生率为7.0%。其中3例术后1～4月内主钉松动退出,股骨颈变短,出现不同程度的髋内翻;3例术后2～5月内发生股骨头切割现象,钉头切割穿出。结论 DHS治疗股骨粗隆间骨折发生失败与病例选择不当、主钉位置不佳、骨折复位不良、骨质质量差和过早负重等因素有关。

Objective To investigate the failed cause of DHS to treat intertrochanteric fracture and produce a reliable solution for the prevention and cure.Methods Using the methods of retrospective review,We have collected 86 cases of intertrochanteric fractures treated by DHS fixation between July 2003 and June 2008 and followed for a minimum of year.We classified the fractures according to Evans system.The postoperative radiographswere examined for failure of reduction,varus angulation 〉100°,perforation of the femoral head,more than 20mm extrusion of a lag screw ormetal failure.Results The mean follow-up period was 37.5 months in 86 cases,and complications and failure occurred in 6 cases w ith the failure rate of 7.0%.Internal fixation was unstable in 3 cases.The femoral neck became shorter and 3 cases suffered hip varus in 1～4 monthes after the operation.3 hip screws were cut out of the femoral head in 2～5 monthes after the operation.Conclusion Complication and failure of DHS to treat intertrochanteric fracture related with the choice of operative indications,poor location of the main screw,bad bone repositioning,osteoporosis and early weight-bearing.