动力髋螺钉在股骨转子间骨折治疗中的应用价值

目的 探讨动力髋螺钉(DHS)在治疗各类股骨转子间骨折中的疗效及应用价值.方法 回顾性研究1997年1月至2007年1月应用DHS内固定治疗198例股骨转子间骨折的患者资料,从手术时间、术中出血量、术后引流量、术中及术后并发症、负重时间、DHS在股骨头的位置、尖顶距、X线愈合时间、髋关节功能恢复率等方面比较不同类型骨折(按AO/OTA 31-A1、31-A2、31-A3不同分型分为3组)的治疗效果.结果 198例患者中有170例完成随访,平均随访时间52.7个月(8-121个月).术中并发症5例,术后并发症15例.髋关节功能恢复程度参照Zuckerman等的髋部骨折专用评分标准:优130例,良30例,较差2例,差8例,优良率为94.1%.各组除在术中出血量、术后引流量、负重时间、X线愈合时间方面差异有统计学意义(P＜0.05)外,在手术时间、并发症发生率、髋关节功能恢复率等方面的差异无统计学意义(P＞0.05).结论 DHS是治疗稳定型股骨转子间骨折的有效方法,在不稳定型骨折中,如术后管理得当亦可取得良好的疗效.

Dynamic hip screws in treatment of intertrochanteric fractures

Objective To investigate clinical value of dynamic hip screws (DHS) in treatment of different types of intertrochanterie fractures. Methods We retrospectively reviewed 198 patients who had been treated for intertrechanteric fractures with DHS between January 1 997 and January 2007.The data of 3 subgroups (AO/OTA 31-A1,31-A2 and 31-A3) were collected for statistical analysis of the following aspoets: operating time, blood loss, drainage, intraoperative complications, postoperative eomplieations, time to weight-bearing, X-ray union time, lag-screw position in the femoral head, tip-apex distance, and Functional Recovery Score (FRS). Results of this group, the 28 patients who had inadequate follow-up were exeluded from the study. The mean follow-up time was 52.7(8 to 121)months. Intraoperative complications occurred in 5 cases, and postoperative ones in 15.By FRS,130 cases were rated as excellent,30 as good,2 as fair, and 8 as poor. The differences in blood loss, drainage, time to weight-bearing and X-ray union time between the 3 subgroups were of statistical significance (P＜0.05),but operating time, intraoperative complications, postoperative complications, tip-apex distance, and FRS showed no significant differences between the 3 subgroups. Conclusion DHS is an effective way of treating stable intertrochanteric fractures, but good results can be achieved for unstable fractures if postoperative management is conducted properly.