动力髋螺钉内固定治疗股骨粗隆间骨折失败因素分析

目的分析动力髋螺钉内固定治疗股骨粗隆间骨折的失败因素。方法对102例股骨粗隆间骨折采用动力髋螺钉内固定失败的19例病例资料进行回顾分析。结果19例失败病例中，9例因内固定松动髋内翻，5例钉穿出，3例钢板拨钉，1例髋螺钉退出，1例钢板折断。失败因素与骨折的严重程度、骨质疏松、忽视内侧结构重建、术中操作不当、康复训练不当等有关。结论骨折严重程度和骨质疏松是导致动力髋螺钉失败的主要因素。术中重视内侧支持结构重建，严格规范手术操作，正确指导康复锻炼及抗骨质疏松治疗，可减少失败发生。

Analysis of the factors of failure in the treatment of femoral intertrochanteric fractures by dynamic hip screw

Objective To analyze the factors of failure in the treatment of femoral intertrochanteric fractures by dynamic hip screw(DHS).Methods Nineteen cases of failure which occurred in 102 cases of femoral intertrochanteric fractures treated by DHS fixation were reviewed,and the factors of failure were analyzed.Results Nineteen cases of failure included coxa vara and looseness of fixation in 9 cases,penetration of screw in 5 cases,pullout of screw of plate in 3 cases,pullout of hip screw in 1 case,breakage of plate in 1 case.The factors of failure were related to the degree of fracture,osteoporosis,neglect of reconstruction of medial sustain structure,non-standard operative procedure,improper rehabilitation training. Conclusion The degree of fracture and osteoporosis are the main factors of failed dynamic hip screw fixation.The failure can be decreased by emphasis of reconstruction of medial sustain structure,accurate operative manipulation,proper guide of rehabilitation training and treatment of osteoporosis.