附加防旋钉在动力髋螺钉治疗股骨转子间骨折中的疗效观察

Effect of adjunctive anti-rotation screw in treating intertrochanteric fractures with dynamic hip screw

目的观察附加防旋钉在动力髋螺钉(DHS)治疗股骨转子间骨折中的作用与疗效。方法 57例股骨转子间骨折患者,根据所采用内固定方式分为DHS附加防旋钉组(A组,32例)和DHS组(B组,25例)。观察两组手术时间、术中出血量、住院时间、尖顶距(TAD)、骨折复位质量(参照Garden标准)、骨折愈合时间、末次随访时Harris评分并进行比较。结果 57例手术切口均甲级愈合。患者均获随访,时间14～31个月。骨折均愈合,无内固定松动、断裂及严重移位等并发症发生。手术时间、术中出血、住院时间、>25 mm TAD值(%)、骨折复位质量差(%)、骨折愈合时间:A组分别为92.4 min±24.5 min、365.7 ml±70.1 ml、16.5 d±4.5d、3.1%、6.2%、10.1周±2.1周;B组分别为88.7 min±23.1 min、360.4 ml±68.7 ml、17.5 d±3.5 d、4.0%、8.0%、10.8周±2.6周;两组比较差异无统计学意义(P>0.05)。末次随访时Harris评分:A组为88.7分±10.7分,B组为82.1分±11.2分,两组比较差异有统计学意义(P<0.05)。结论附加防旋钉具有较好的抗张力和防旋转作用,可改善骨折固定稳定性,结合DHS是治疗股骨转子间骨折的较好方法。

Objective To investigate the effect and surgical outcome of adjunctive antirotation screw fixation in treat- ment of intertrochanteric fractures. Methods 57 cases of intertrochanteric fractures were reviewed retrospectively. 32 cases underwent DHS with adjunctive antirotation screw （group A） ,while 25 cases experienced DHS fixation （group B ）. The data of operation time, blood loss, hospital stay time, tip-apex distance（ TAD）, quality of fracture reduction （ Garden Standard）, union time, preoperative and final follow-up Harris scores were recorded. Reslrlts All 57 cases got incision healing by first intension without observed intraoperative complications such as loosening, breakage, or grievous migration of implant. All patients were followed up for 14 to 31 months. The operative time, blood loss, hos- pital stay time, 〉25 mm TAD（% ）, poor quality of fracture reduction（% ） ,union time were 92.4 min ±24. 5min, 365.7 ml ＋ 70. 1 ml, 16. 5 d ± 4. 5d,3.1% ,6. 2%, 10. 1 weeks ± 2. 1 weeks in group A, and were 88.7 rain ＋ 23.1 min, 360.4 ml ±68. 7 ml, 17. 5 d±3.5 d, 4.0%, 8.0%, 10. 8 weeks ±2. 6 weeks in group B. The indexes above showed no significant difference between the two groups （ P 〉 0.05 ）. Final follow-up Harris hip scores were 88.7 ± 10. 7 in group A, and were 82. 1± 11.2 in group B. At final follow-up, Harris scores showed significant difference（P 〈 0. 05 ） between the two groups. Conclusions Adjunctive antiretation screw can provide counteraction of tension and rotation, promote fixation stability. It appears relatively more convenient with equivalent effect. Dynamic hip screw （DHS） with adjunctive antirotation screw fixation is optional for intertrochanteric fractures.