不稳定股骨转子间骨折的内固定选择及术后并发症原因分析

Selection of internal fixation and causes of post-operative complications for unstable intertrochanteric fractures

目的探讨不稳定股骨转子间骨折的内固定方法选择,分析术后并发症的原因。方法 67例不稳定股骨转子间骨折患者,采用DHS内固定41例、DCS内固定3例、Gamma钉内固定7例、PFN内固定11例、PFNA内固定5例。结果 67例均获随访,时间6～68个月。参照董纪元等推荐的疗效评定标准:优35例,良19例,可8例,差5例,优良率为80.59%。术后并发症:DHS内固定41例中发生髋内翻5例,股骨颈干角变小5例,患肢短缩1例;Gamma钉内固定7例中发生股骨颈干角变小1例;PFN内固定11例中发生患肢短缩1例。结论不稳定股骨转子间骨折应首选髓内固定;内固定选择不当、术中操作失误及术后过早负重锻炼是术后并发症发生的主要原因。

Objective To investigate the selection of proper internal fixation devices for unstable intertrochanteric fracture and analyze the causes of post-operative complications.Methods 67 patients of unstable intertrochanteric fracture were treated operatively with internal fixation,of which 41 patients were treated with dynamic hip screw（DHS）,3 patients were treated with dynamic condylar screw（DCS）,7 patients were stabilized intramedullarily with Gamma nail,11 patients were stabilized intramedullarily with proximal femoral nail（PFN） and 5 patients were stabilized intramedullarily with proximal femoral nail anti-rotation（PFNA）.Results 67 patients were followed up for 6～68 months.According to Dong Ji-yun et al therapeutic effects scheme,the results were excellent in 35 cases,good in 19,fair in 8,and poor in 5.Excellent and good functional results were obtained in 54 patients（80.59%）.The complications caused by DHS（41 cases） included coxa vara（5 patients）,decreasing of angle of declination of femoral neck（5 patients）,and shortening of lower limbs（1 patient）.The complications were found in 1 patient with decrease of angle of declination of femoral neck by Gamma nail（7 cases） as well as 1 patient with shortening of lower limbs caused by PFN（11 cases）.Conclusions Intramedullary fixation for unstable intertrochanteric fractures is very encouraging.The main reasons responsible for complications are such iatrogenic factors as unsuitable implant selection,unskillful surgical technique and improper post-operative instruction for functional exercise.