股骨转子间骨折术后并发症的原因分析及处理

目的探讨动力髋螺钉或动力髁螺钉治疗股骨转子间骨折后发生并发症的原因及其处理。方法1995年1月～2004年12月采用动力髋螺钉或动力髁螺钉内固定治疗215例股骨转子间骨折患者,对术后出现并发症的患者进行分析,探讨其发生并发症的原因及并发症的处理方法。结果所有患者获13～72个月(平均32个月)随访。术后髋关节功能恢复良好率达94．0%。215例患者中31例出现内固定相关术后并发症,其中髋内翻14例,主要发生于股骨转子内后方存在明显骨折碎裂的患者；骨折延迟愈合12例,为骨折累及股骨距及小转子,术中做软组织广泛剥离、骨折复位固定的患者；内固定物股骨头颈内切割并螺钉穿入髋关节腔5例,其中3例再行人工关节置换,关节功能Harris评分为82分。结论内固定物选择不当是导致术后并发症的重要原在,而不稳定性骨折、严重骨质疏松及骨折复位不良都将增加手术并发症的发生率．

Analysis of complications after treatment of femoral intertrochanteric fractures with internal fixation

Objective To analyze causes for postoperative fixation-related complications of femoral in- tertrochanteric fractures treated with dynamic hip screws(DHS)and dynamic condylar screws(DCS).Methods From January 1995 to December 2004,215 cases of intertrochanteric fracture were treated with DHS/DCS.Their postoperative fixation-related complications were analyzed to find out the causes.Results All cases were followed up for 13 to 72 months(mean,32 months).The rate of excellent and good functional recovery of hip was 94.0%. Postoperative internal-fixation-related complications occurred in 31 cases,including hip varus in 14 cases who had posterior intertrochanteric fragments,delayed union of fracture in 12 cases who had fractured calcar and lesser trochanter and massive dissection of soft tissues,and cutting-out of lag screws in five cases,three of whom had to receive prosthetic replacement.Conclusions Unsuitable implant selection is an important factor leading to postoperative fixation-related complications.Unstable fracture,serious osteoporosis and unsatisfactory reduction will increase the incidence of complications.