动力髋螺钉内固定股骨头切出的原因分析及对策

Analysis of Cut-out from Femoral Head about DHS and Treatment Countermeasure

目的 分析动力髋（DHS）内固定致股骨头切出的原因及预防措施。方法 总结自2000年~2011年应用动力髋固定195例股骨转子间骨折的治疗经验,对19例动力髋螺钉切出股骨头失败病例进行分类及分析。结果 195例患者均获得3~22个月（平均16个月）随访,19例发生切出股骨头（9.74%）。分析失败病例,其中尖顶距（TAD）值〉25 mm 9例。A1型1例,A2型4例,A3型14例。动力髋螺钉位置于股骨颈中心者7例,偏离中心者12例。结论 “TAD”值过大、骨质疏松患者术后过早活动、内固定选择不合适、术中操作不当是动力髋螺钉切出的重要因素。

Objective To analyse the reason of cut-out from femoral head about DHS and provide theoretical basis for clinical appilation of DHS. MethodsThe 195 cases treatment experiences were summarized with DHS method from 2000 to 2011. The classification of femoral head resection was analyzed. Results The duration of the follow-up ranged from 3 to 22 months（ 16 months on average）. There were 19 cases with the cut-out of the lag screw from the femoral head following internal fixation（9.74%）. Analysis of failure cases, the tip apex distance（TAD） value exceed 25 mm in 9 cases. Type A1 1 cases, type A2 4 cases, type A3 14 cases. The screw position display screw position in the femoral neck center in 7 cases, 12 cases of deviation from the center. Conclusions The greater the＂TAD＂value,the osteoporosis in patients with postoperative early activities, internal fixation selection is inappropriate, improper operation is an important factor of dynamic hip screw cut out.