医源性因素对DHS治疗髋部骨折疗效的影响

目的探讨动力性髋螺钉(dvnamic hip screw，DHS)治疗髋部骨折中出现的各种失误和并发症与医源性因素的关系，并提出相应对策。方法 回顾总结316例DHS治疗髋部骨折中出现的失误和并发症，并分析其原因。结果258例得到随访，32例出现了不同程度的失误和并发症，发生率12．4％。其中因失误致颈钉位置欠佳6例，长度不当4例；术后并发症颈钉穿出股骨头4例；术后切口感染3例，其中骨不愈合1例；髋内翻4例，其中钢板断裂1例；畸形愈合6例；下肢外旋畸形2例；骨不愈合3例。结论 DHS治疗髋部骨折疗效肯定，出现的失误和并发症与术前准备、适应症的选择、DHS的选用、手术技术及术后功能锻炼指导等医源性因素有关。

Effects of iatrogenic factors on curative outcome of hip fracture treatment with DHS

Objective To analyze the correlation between iatrogenic factors and errors and complications which occur in the treatment of hip fractures using dynamic hip screw (DHS) and put forward the countermeasures. Methods 316 cases of hip fractures who had been treated with DHS were reviewed. The causes for errors and complications were analyzed. Results 258 cases were followed up for 12 months to 75 months (averaging 42.6 months). Different degrees of errors and complications occurred in 32 cases, with the incidence being 12.4%. Among them, the operative mistake resulted in the wrong position of the neck nail in 6 cases, and inappropriate length of the neck nail in 4 cases. The postoperative complications included the worn off femoral head by neck nail in 4 cases,incision infection in 3 cases,1 of which had fracture nonunion, coxa vara in 4 cases,1 of which had broken steel plate, malunion in 6 cases, abnormal external rotation in 2 cases and fracture nonunion in 3 cases. Conclusion The curative outcome of hip fracture treatment with DHS is affirmative, for the errors and complications are related to such iatrogenic factors as inadequate preoperative preparation, improper DHS choice, unskillful surgical technique, and improper postoperative instruction for functional exercise.