动力髋螺钉治疗股骨粗隆间骨折失败原因分析

An Analysis of Failure Factors in Treatment of Femoral Intertrochanteric Fracture with A Dynamic Hip Screw

目的 探讨动力髋螺钉(DHS)治疗股骨粗隆间骨折失败的原因。方法 总结1994～2001年用DHS治疗的69例股骨粗隆间骨折的治疗经验。对其中失败的19例进行分类,探讨相关原因。结果 69例中有19例失败,失败的类型分为6型:加压钉穿出股骨头、加压钉位置不良、加压钉切割股骨头颈、髋内翻、套接钢板断裂螺钉松动、局部骨吸收。患者年龄、骨折类型、骨的质量、手术技术、内固定材料强度、手术适应证的选择是失败的相关原因。结论 选择DHS治疗股骨粗隆间骨折应根据患者的年龄、骨质量、骨折类型掌握好适应证。对高龄不稳定型骨折DHS不应首选。

Objective To analyse failure factors treating femoral intertrochanteric fracture with a dynamic hip screw (DHS). Methods Sixty-nine cases of intertrochanteric fracture were treated by DHS from 1994 To 2001, 19 were failure. The failure cases were analysed to find out the factors. Results Failure factors were divided into 6 types, femur head perforation of crew, misplacement of screw, screw cuting femur neck, hip varus, plate broken and screw loosen, and local bone absorption. Failure relative factors were regarded to age, type of fracture, quality of bone, operation technique, quality of plate and screw, and choice of operative indication. Conclusion Using DHS to treat intertrochanteric fracture must be on the basis of age, quality of one, type of fracture. DHS should not be the first choice for treatment of old patient with unstable fracture.