改良粗隆下截骨结合动力髋螺钉内固定治疗股骨粗隆间骨折术后髋内翻与短缩畸形

Improved subtrochanteric osteotomy combined with dynamic hip screw for internal fixation

目的探讨改良粗隆下截骨结合动力髋螺钉（dynamic hip screw，DHS）治疗股骨粗隆问骨折术后髋内翻与短缩畸形的临床疗效。方法15例粗隆间骨折术后发生髋内翻与短缩畸形患者，采用改良粗隆下截骨结合DHS内固定矫治，术后均早期功能锻炼。观察股骨颈干角及患肢缩短的纠正，并发症的发生情况，以及髋部Harris评分改善情况与改善率。结果所有患者均获得随访，时间3个月～3．2年，平均2．5年。术后所有患者股骨颈干角均恢复正常，患肢缩短〈1cm，术后Harris评分较术前大为提高，患者术后平均改善率达93％，无一例严重术后并发症发生。结论改良粗隆下截骨结合DHS内固定术治疗股骨粗隆问骨折术后髋内翻疗效显著。

Objective To investigate the clinical outcomes of improved subtrochanteric osteotomy combined with dynamic hip screw（DHS） for coxa vara and short deformity after operation of femoral inter- trochanteric fracture. Methods A total of 15 patients with coxa vara short deformity after operation of femoral intertrochanteric fracture. All patients underwent improved subtrochanteric osteotomy combined with DHS and early exercises. Collodiaphyseal angle, correction of the short deformity, condition of compli- cations and Harris score were observed. Results All patients were followed up for 3 months to 3.2 years （ mean 2.5 years）. All collodiaphyseal angle of femur became normal and the shortening of lower limb was less than 1 cm. The postoperative Harris score was greatly improved. And the postoperative improve rate was 93%. No severe complication occurred during follow-up period. Conclusion Improved subtrochanter- ic osteotomy combined with DHS can get satisfactory clinical outcomes for coxa vara after operation of fem- oral intertrochanteric fracture.