改良DHS手术治疗股骨粗隆间骨折

[目的]采用改良动力髋螺钉(dynamic hip screw,DHS)手术治疗股骨粗隆间骨折,分别和传统DHS、股骨近端髓内钉(PFN)相比较。[方法]对54例股骨粗隆间骨折患者采用改良DHS手术治疗包括术前重视骨牵引、术中内旋患肢、采用股骨近端后外侧切口、切断股外侧肌起点的方法。并和传统DHS组39例、PFN组33例相对照比较,得出术前骨牵引率、术中复位满意率、手术时间、出血量、优良率等多项观察指标的相关数据,并进行统计分析。[结果]54例获得13～28个月的随访,平均19.2个月。资料分析显示,DHS改良组和PFN相比较,在手术时间、失血量及愈后功能评价等方面无显著性差异;和传统组相比较,改良组可缩短手术时间、减少术中失血量并缩短切口长度。[结论]用改良后的DHS手术治疗EvansⅠ、Ⅱ型股骨粗隆间骨折有一定的临床应用价值。

Treatment of intertrochanteric femur fractures with modified dynamic hip screw

[Objective] To compare the treatment of intertrochanteric femur fractures by modified dynamic hip screw(DHS),traditional DHS and proximal femoral nail(PFN).[Method]Fifty-four patients with intertrochanteric femur fractures were treated with modified DHS,including paying attention to preoperative skeletal traction,intraoperative affected limb internal rotation,proximal femur posterolateral incision and cut off in the starting point of vastus lateralis.Traditional DHS were used in 39 cases and PFN were used in 33 cases.The rate of preoperative skeletal traction,the satisfaction rate of intraoperative reduction,operative time,blood loss,excellent and good result rate were recorded and statistically analyzed.[Result]All patients were followed up for 13-28 months,19.2 months on average.The results of analysis showed that no statistically significant differences were found in the operative time,the intraoperative blood loss and the evaluation function of postoperative between modified DHS and PFN.However,compared with traditional DHS,modified DHS may shorten the operation time,reduce the intraoperative blood loss and shorter incision length.[Conclusion]The treatment of Evans type Ⅰ,Ⅱ intertrochanteric femur fractures with modified DHS has certain clinical application value.