中青年军人术后拉力螺钉切出股骨头与尖顶距关系的回顾性分析

Relationship between cut-out of lag screw from femoral head and tip-apex distance in young and middle-aged soldiers:a clinical retrospective study

目的分析尖顶距(tip-apex distance,TAD)值与动力髋(DHS)拉力螺钉切出股骨头的关系。方法回顾性分析我院2005年1月～2010年1月接受切开复位动力髋螺钉(DHS)内固定且病例资料完整的军人股骨粗隆间骨折24例,其中男性21例,女性3例,平均29岁(19～42岁)。根据Baumgaertner等提出的预测拉力螺钉切出股骨头的TAD预测值(25 mm)进行分组,A组(TAD值≤25 mm)19例,B组(26 mm≤TAD值≤45 mm)4例,C组(TAD值≥46 mm)1例。结果本组24例患者均获得4～21个月(平均16个月)随访,3例术后发生拉力螺钉切出股骨头,其中B组2例,C组1例。结论中青年军人股骨粗隆间骨折动力髋拉力螺钉切出股骨头导致内固定失效与TAD值显著相关,TAD值越高,拉力螺钉切出股骨头的危险性越大。

Objective To analyze the relationship between the cut-out of dynamic hip screw（DHS）from the femoral head and tip-apex distance（TAD）in young and middle-aged soldiers.Methods The complete radiographic and clinical data of 24 young and middle-aged soldiers with femoral intertrochanteric fractures who received internal fixation with DHS in our hospital from January 2005 to January 2010 were retrospectively analyzed.There were 21 men and 3 women with an average age of 29 years（19-42 years）.They were divided into three groups according to the predictive value of TAD（25 mm）：group A（TAD≤25 mm,n=19）,group B（26 mm≤TAD≤45 mm,n=4）and group C（TAD≥46 mm,n=1）.Results The duration of the follow-up ranged from 4 to 21 months（16 months on average）.There were three patients with the cut-out of the lag screw from the femoral head following internal fixation.Among them,two cases belonged to group B,and one cases belonged to group C.Conclusion The cut-out of the lag screw from the femoral head resulting in internal fixation failure is significantly correlated with TAD value.The higher TAD value is,the greater possibility of cut-out occurs.