动力髋螺钉治疗股骨粗隆间骨折并发症分析

目的：分析动力髋螺钉钢板系统（dynamic hip screw，DHS）治疗股骨粗隆间骨折的并发症及其原因。方法：2002年1月至2007年12月69例股骨粗隆间骨折采用DHS治疗，男27例，女42例；年龄53-96岁，平均72．9岁；按照Evans骨折分型：Ⅰ型10例，Ⅱ型21例，Ⅲ型22例，Ⅳ型16例。术前已明确诊断的各种内科系统伴随症的51例（73．9％），观察分析其并发症的发生情况。结果：57例出院后通过门诊及电话获得随访，随访时间8-70个月，平均41个月。围手术期发生全身系统并发症17例，死亡4例；手术局部相关并发症12人18例次。其中包括滑动髋螺钉松动后退4例、拉力螺钉穿破股骨头3例、钢板断裂1例；髋内翻5例；深部组织感染再次手术取出内固定1例；伤口愈合不良2例，骨折延迟愈合2例。结论：不稳定性粗隆间骨折应用DHS内固定失败的发生率较高，不应作为治疗首选。应根据骨折分型，结合老年患者骨质疏松情况，选择适当的术式，充分重视高龄患者系统性疾病的预防和监护，可以提高股骨粗隆间骨折的疗效并减少术后并发症。

Complications of surgical treatment for femoral intertrochanteric fractures using dynamic hip screw

Objective：To investigate the complications of surgical treatments for femoral intertrochateric fractures using dynamic hip screw （DHS）. Methods：From Jan. 2002 to Dec. 2007, sixty-nine patients with intertrochanteric fractures were treated by dynamic hip screw fixation included 27 males and 42 females,with an average age of 72.9 years ranging from 53 to 96 years. According to Evans classification there were 10 cases in type Ⅰ ,21 in type Ⅱ ,22 in type Ⅲ ,and 16 in type Ⅳ ,of which 51 patients （73.9%） suffered from systematic diseases preoperatively. Results：Fifty-seven patients were followed up for 8 to 70 months （41 months on average）. Four patients died, 17 cases occurrenced systematic complications postoperatively. Internal fixation related complications occurred in 12 patients. There were 8 cases with mechanical failure of DHS including 4 of screw loosen, 3 of cutting-out of device through femoral head and neck and 1 of plate breakage. Five patients had a coxa vara, and delayed union occurred in 4 patients. Cnclusion： Unstable fracture pattern produced high percentage of mechanical failure. In such cases DHS should not be the first choice for treatment. The appropriate treatment should be in relation to pre-operative fracture stability and osteoporosis.