动力髁螺钉在股骨粗隆周围骨折中的应用

Treatment of Peritrochanteric Fracture with the Dynamic Condylar Screw

目的 :探讨动力髁螺钉 (DCS)在股骨粗隆周围骨折中的应用及并发症原因。方法 :对 2 0例股骨粗隆周围骨折 (粗隆间骨折 12例 ,粗隆下骨折 8例。其中粗隆间骨折根据Evans分型方法 :Ⅰ型 10例 ,均为不稳定型 ;Ⅱ型 2例。)采用间接复位DCS内固定治疗。结果 :经 8个月～ 3年 (平均 2年 )的随访 ,骨折全部愈合 ,尚存 1例轻度髋内翻等并发症。结论 :动力髁螺钉 (DCS)治疗股骨粗隆周围骨折是DCS的一种新用途 ,是其他内固定的一个补充。适用于不稳定型的粗隆间骨折和特别靠近近端的粗隆下骨折 ,当术中其他内固定造成大粗隆游离 ,影响固定效果时 ,可改用DCS固定补救。应用间接复位技术 ,不需要固定小粗隆或内侧小粗隆植骨。术中反复穿钉、术后过早负重 ,可能是引起髋内翻的原因。

Objective:To study the indications and complications in treatment of peritrochanteric fracture with the dynamic condylar screw(DCS).Methods :Twenty patients who sustained an unstable peritrochanteric fracture were performed indirectly reduction and fixation using a dynamic condylar screw.Twelve cases with intertrochanteric fracture (Evans classification:Type Ⅰunstable 10 cases;Type Ⅱ2 cases)and eight cases with subtrochanteric fracture.Results:Follow-up eight months to three years,mean two years.All fracture healed.There is only one case has a complication of minor varus hip.Conclusion:Treatment of peritrochanteric fracture with the dynamic condylar screw is a new application of DCS.It has the better results and can be an alternative treatment for peritrochanteric fractures in particular of unstable intertrochanteric fractures as well as subtrochanteric fractures.DCS is indicated for peritrochanteric fractures with greater trochanter extension failing by other devices.By means of indirectly reduction and fixation technique,it need not to stabilize the lesser trochanter as well as bone grafting.Repeating to insert the lag screw and early weight bearing might cause coxa vara.