影响动力髋螺钉治疗A2型股骨转子骨折疗效的相关因素

目的探讨影响动力髋螺钉（DHS）内固定治疗A2型股骨转子骨折疗效的相关因素,总结治疗经验。方法采用DHS治疗单侧A2型股骨转子骨折患者61例。根据Merle D′Aubigne和Salvati-Wilson两种髋关节功能评分法评定患者术后髋关节功能恢复情况,记录患者下地负重行走的时间。结果61例均获得随访,时间3～18个月。骨折均愈合,愈合时间2～4（2.5±0.7）个月。下地负重行走时间1～4（2.7±0.8）个月。1例在随访4个月时因脑溢血死亡,3例出现髋内翻,未出现骨折处感染、继发骨折、螺钉穿出股骨头和钢板断裂病例。按Merle D′Aubigne髋关节功能评分：优8例,良47例,中6例,优良率90.9%;按Salvati-Wilson髋关节功能评分：优7例,良48例,中6例,优良率92.5%。结论内固定安置正确,注意对股骨小转子复位和内侧结构的重建,适当延迟下地时间,可以取得良好的效果。

Factors relating to the effect and rehabilitation of A2 type intertrochanteric fractures fixed with dynamic hip screws

Objective To study the factors related to the effect and rehabilitation of A2 type intertroehanterie fi＇actures fixed with dynamic hip screws. Methods 61 patients with unilateral A2 type femoral intertrochanteric fi＇aetures treated with DHS were collected. The follow-up was carried out to evaluate the function regaining according to the Merle D＇Aubigne and Salvati-Wilson hip scores, the weight-bearing ambulation time was requested. Results All the patients were followed up for 3 - 18 months. 1 died of cerebral apoplexy in 4 months ＇,after the operation. All the fictures were union （2 - 4 months, mean 2.5 ± 0. 7 months） without infection, stress fracture, nail penetration or plate breakage but 3 had coxa rata. The weight-bearing ambulation time was 1 - 4 months,mean 2.7 ± 0. 8 months. According to the Merle D＇Aubigne hip score：8 were excellent,47 good,and 6 fair,and the excellent and good rate was 90. 0%. According to the Salvati-Wilson hip score ：7 were excellent ,48 good ,6 fair, and the excellent and good rate was 92.5%. Conclusions With proper internal fixation,attention to the apposition of the lesser trochanter and postponing the weight-bearing ambulation time properly,the result of intertrochanteric fracture treated with DHS will be satisfied.