股骨粗隆间骨折内固定失效的原因与预防

Reasons and preventions of internal fixation operation failure of intertrochanteric fractures

[目的]探讨股骨粗隆间骨折内固定失效的原因,提出预防的方法。[方法]自2002年1月～2008年12月采取不同的手术内固定方式治疗股骨粗隆间骨折175例,获随访158例,随访时间7～48个月,平均21个月。研究这158例病例信息与影像资料,对内固定失效病例,分析其原因,并探讨预防措施。[结果]手术内固定不完善27例(17%),内固定失效10例(6.3%)。拉力螺钉切割股骨头3例,拉力螺钉穿透股骨头2例,拉力螺钉退钉5例,股骨头外移1例,髋内翻2例,拉力螺钉深度不够6例,股骨颈变长1例,股骨头旋转、内固定物松动1例,骨折延迟愈合4例,骨折不愈合2例。[结论]内固定失效的原因:拉力螺钉的深度和位置不良,内固定方式选择不当,髋内翻未纠正,小粗隆骨块处理的疏忽,骨质疏松,过早负重。

[Objective]To analyze reasons which lead to the failure of the internal fixation for the intertrochanteric fracture and put forward preventive methods.[Method]From January 2002 to December 2008,175 cases of intertrochanteric fracture patients were treated by means of varies kinds of internal fixations.Totally 158 patients were followed up for a mean time of 21 months（ranged from 7 to 48 months）.Trauma and treatment informations and radiongraphs were studied to find out the reasons of operation failure and indicate the methods to prevent the complications.[Result]Among the internal fixation operation cases,27 cases were not perfect（17%）,10 were failure（6.3%）.Cutting-out femoral heads by lag screws occurred in 3 cases,lag screw penetrating femoral heads 2 cases,pulling of the lag screws 5 cases,abduction of the femoral head 1 case,coxa adducta 2 cases,too short lag screws 6 cases,lenthening of the femoral neck 1 case,rotation of the femoral head 1 case,delayed union of fracture 4 cases,non-union of fracture 2 cases,lessening of fixation 1 case.[Conclusion]The reasons for the failure of internal fixation are：unsatisfactory length and location of the lag screw fixation,inappropriate method,the coxa vara uncorrected,lesses trochanter osteoporosis,too early weinght bearing.