动力髋螺钉治疗转子间骨折临床分析

目的评价应用动力髋螺钉（DHS）治疗股骨转子间骨折的疗效,探讨其治疗经验和手术技术。方法 2004年12月-2009年9月,36例股骨转子间骨折患者采用DHS治疗,男性14例,女性22例;年龄44～94岁,平均75.7岁。骨折参照Tronzo～Evans分类方法分型：Ⅰ型3例,Ⅱ型5例,Ⅲ型15例,Ⅳ型10例,Ⅴ型3例,均为闭合性骨折。用Mer-led’Aubigne评分法评价术后髋关节功能。结果 36例均得到随访,术后随访3～19个月,平均16.8个月。4例（11.1%）拉力螺钉松动、部分退出,3例（27.3%）拉力螺钉切割,4例（11.1%）出现髋内翻畸形,1例（2.8%）导针折断残留,30例（83.3%）术后髋关节功能优良。结论伴随内科疾病以及骨质疏松的积极治疗、颈干角精确复位、拉力螺钉植入理想位置、熟练的手术技巧以及个性化的术后康复对降低DHS治疗转子间骨折的风险及提高疗效十分重要。

Clinical Analysis of Dynamic Hip Screw for Intertrochanteric Fracture

Objective To evaluate the clinical results of Dynamic Hip Screw（DHS）for treatment of intertrochanteric fracture and to explore the treatment experience and operation points.Methods From December 2004 to September 2009,36 patients with intertrochanteric fracture were treated with DHS.There were 14 males and 22 females.The mean age was 75.5 years with a range of 44-94 years.According to Tronzo-Evans classification system,3 cases belonged to type Ⅰ fracture,5 type Ⅱ,15 type Ⅲ,10 type Ⅳ,and 3 type Ⅴ.All patients were closed fracture.Postoperative function of the hip were evaluated by Merle d＇Aubigne score.Results All patients were followed up from 3 to 19 months with the average of 16.8 months.looseness and pullout of lag screw in 4（11.1%）cases,cutout of leg screw in 3（27.3%）cases,coxa vara in 4（11.1%）cases,guide pin broken in 1（2.8%）case.excellent and good function of the hip in 30（83.3%）cases.Conclusion For the intertrochanteric fracture,it is very important to treat the accompanying medical diseases expeditiously,recognize underlying osteoporosis and treat it accordingly,reconstruct the collodiaphyseal angle,perform accurate reductions with ideal implant placsment,operate with skilled surgical technique and guide the patients in their postoperative function exercise.DHS associated with all this can result in low risk and effectively improve the outcome.