应用解剖学定位方法置入动力髋螺钉治疗股骨粗隆间骨折的临床疗效观察

Anatomic locating method of dynamic hip screw on the treatment of intertrochanteric fracture and its clinical efficacy

目的探讨应用解剖学定位方法置入动力髋螺钉治疗股骨粗隆间骨折的临床疗效。方法通过解剖学观察,在股骨近端外侧面纵向中央线上,从斜坡顶点向下延续一与斜坡顶点以下2.0 cm处的股骨外侧面的前后直线距离相等的长度而确定一点,该点即为使动力髋螺钉的颈钉位于股骨颈中央的股骨外侧的入钉点。应用该方法治疗37例股骨粗隆间骨折,术后在X线片上测量动力髋螺钉的颈钉在股骨颈中的位置及采用Harris疗效评定标准评价临床疗效。结果术后X线片显示:动力髋螺钉的颈钉位于股骨颈中央部位33例,位于股骨颈下部3例,位于股骨颈上部1例。随访30例,随访时间6～16个月,平均10个月。骨折全部愈合,愈合时间3.0～4.5个月。采用Harris疗效评定标准进行评价,其中优23例,良5例,可2例,优良率93%。结论应用解剖学定位方法置入动力髋螺钉治疗股骨粗隆间骨折时能够使动力髋螺钉的颈钉位于股骨颈中央部位,对提高手术质量、缩短手术时间、减少X线对手术人员的辐射等方面具有重要的临床意义。尤其对于手术时没有床旁X线仪器的基层医院其临床意义更为重要。

Objective To evaluate the clinical efficacy of anatomic locating method of dynamic hip screw（DHS） on the treatment of intertrochanteric fracture.Methods On the vertical central line in the proximal femoral external sides,the point was extended down from the slope top point a length which is equal to the AP straight distance 2.0cm below slope top point and to find one point.After these extension,the point is considered as the anchor point of DHS.37 patients was treated with intertrochanteric fractures femoral using the anatomic locating method of DHS.After these treatment,the position of neck screws of DHS in postoperative X ray films was measured to evaluate clinical efficacy.Results The postoperative X ray films showed that the neck screw of DHS was located in the central part of femoral neck in 33 cases,3 cases in the lower part of the femoral neck,1 case in the upper part of femoral neck.30cases were followed up for 6 to 16 months,average follow-up time is 10 months.All fractures healed.The healing time ranged from 3 to 5.5 months,average 4.1 months.The heal result was evaluated using Harris system.The system showed the treatment was excellent in 23 cases,good in 5 cases.The total excellent rate of the function was 93%.Conclusion The anatomical localization method of DHS on treatment of femoral intertrochanteric fracture can locate the neck screw of DHS in the central part of the femoral neck.This method has the important clinical significance for improving surgery quality,shortening operating time,reducing radiation of X ray to the operation personnel,especial for the basic level hospital without the x-way instruments during the operation.