动力髋螺钉与防旋阻挡钉联合修复不稳定型股骨转子间骨折

背景：严重的股骨转子间骨折,其抗旋转能力差,单单动力髋螺钉内固定容易失败.如内固定后出现股骨头塌陷、股骨颈短缩、小转子内侧失稳髋内翻、头颈旋转、头颈切割穿钉、钢板拨钉及钢板断裂等现象.故对于不稳定型股骨转子间骨折,动力髋螺钉内固定有一定的局限性.目的：探讨动力髋螺钉联合防旋阻挡钉置入内固定对不稳定型股骨转子间骨折的修复效果.方法：选取96例不稳定型股骨转子间骨折患者,分别实施内固定治疗,其中采用动力髋螺钉组48例,动力髋螺钉联合防旋阻挡钉组48例.从手术时间、术中出血量、X射线暴露次数、骨折愈合时间、内固定后Harris髋关节评分及内固定后并发症等方面进行对比评估.结果与结论：内固定后随访时间为18-36个月.动力髋螺钉组和动力髋螺钉联合防旋阻挡钉组在手术时间、术中出血量、X射线暴露次数、骨折愈合时间方面比较差异无显著性意义（P＞0.05）.动力髋螺钉联合防旋阻挡钉组内固定后髋关节评分（Harris评分）高于动力髋螺钉组（P＜0.05）.动力髋螺钉组内固定后并发症发生率（14％）显著高于动力髋螺钉联合防旋阻挡钉组（4％,P＜ 0.05）.提示单纯动力髋螺钉置入内固定修复不稳定型股骨转子间骨折并发症较多,失败率较高;而动力髋螺钉联合防旋阻挡钉能重建股骨后内侧结构,弥补动力髋螺钉的缺点和不足,对不稳定型股骨转子间骨折的修复有重要价值.

Dynamic hip screw combined with antirotation screw in repair of unstable femoral intertrochanteric fractures

BACKGROUND： For severe intertrochanteric fracture, the anti-rotation capability is poor, and single dynamic hip screw fixation easily became failure. For example, collapse of the femoral head, femoral neck shortening, unstable hip varus inside small rotor, head and neck rotating, head and neck cutting and nailing, steel nail out and broken steel appeared after fixation. For unstable intertrochanteric fractures, dynamic hip screw fixation has certain limitations.
OBJECTIVE： To explore the effects of dynamic hip screw combined with antirotation screw in repair of unstable femoral intertrochanteric fractures.
METHODS： A total of 96 cases of unstable femoral intertrochanteric fractures were separately subjected to fixation. There were 48 cases in the dynamic hip screw group and 48 cases in the dynamic hip screw combined with antirotation screw group. The surgical time, intraoperative blood loss, exposure time of X-ray, fracture healing time, postoperative Harris hip score and postoperative complications between the two groups were compared and evaluated.
RESULTS AND CONCLUSION： All the cases were followed up for 18-36 months. The surgical time, intraoperative blood loss, exposure time of X-ray and fracture healing time showed no significant difference between the dynamic hip screw group and dynamic hip screw combined with antirotation screw groups （P 〉 0.05）. Postoperative Harris hip score was higher in the dynamic hip screw combined with antirotation screw group than in the dynamic hip screw group （P 〈 0.05）. The incidence of postoperative complications was significantly higher in the dynamic hip screw group （14%） than that in the dynamic hip screw combined with antirotation screw group （4%; P 〈 0.05）. These data indicated that dynamic hip screw fixation for repair of unstable femoral intertrochanteric fractures showed many complications and high failure rate. However, dynamic hip screw combined with antirotation screw could reconstruct posterior medial femoral structure, make up t