135°DHS治疗股骨粗隆间不稳定骨折的疗效评价  

Clinical Evaluation of Dynamic Hip Screw for Unstable IntertrochaNteric Fracture of the Femur

作　　者：王军[1] 张军威[1] 周莹[2] 

机构地区：[1]张家口医学院第一附属医院骨科,075000 [2]张家口供电公司职工医院,075000

出　　处：《张家口医学院学报》2004年第3期14-16,共3页

摘　　要：目的 :观察DHS治疗不稳定股骨粗隆间骨折的疗效并做出评价。方法 :1996年 9月～ 2 0 0 0年 10月采用DHS治疗不稳定股骨粗隆间骨折 76例。男 4 7例 ,女 2 9例 ,年龄 2 4～ 87岁 ,平均 6 7.6岁。改良Evans分型 :III型 12例 ,IV型 4 2例 ,V型 2 2例。合并颅脑损伤 2例 ,胸部外伤 1例 ,骨盆骨折 2例 ,腰椎骨折 3例 ,同侧股骨下段骨折 1例 ,同侧小腿骨折 2例。2 6例合并内科疾病 ,2 4例为 6 0岁以上患者 ,占 6 0岁以上患者的 5 8.5 % ,其中高血压 17例 ,冠心病 9例 ,心率失常 5例 ,糖尿病 3例 ,脑梗塞 6例 ,慢性支气管炎 3例 ,慢性胃炎 2例 ,十二指肠球部溃疡 1例 ,6 0岁以上患者合并骨质疏松 2 8例。结果 :围手术期本组无一例死亡 ,平均住院时间 16d( 12～ 2 6d) ,术前 2～ 10d ,平均 5 .4d ,住院期间术后并发症 5例 ,2例心功能衰竭 ,3例下肢深静脉血栓。 5 8例获得随访 ,男 34例 ,女 2 4例 ,其中 6 0岁以上患者 32例 ,随访 7～2 6个月 ,3～ 6个月骨折愈合 ,平均 3.5个月。 2例颈干角小于术前评价 ,但大于 110°。无螺钉松动及钢板断裂。根据MerleD&Aubigne[1] 髋关节功能评价标准 :优良率 91%。结论 :DHS是结构坚固的可伸缩内固定装置 ,允许骨折端在装置上滑动以寻求自身的稳定 ,为骨折端提供了静力及动力?Objective: To investigate the clinical effect of DHS for treatment of intertrochanteric fracture of the femur.Methods: From September 1996 to October 2000, 76 cases of unstable intertrochanteric fracture of the femur were treated with DHS. There were 47 males and 29 females. The mean age of the patients was 67.6 years (rang 24～87 years) . According to Evans classification system of intertrochanteric fracture, 12 cases belonged to type III, 42 type IV, 22 type V. Twenty-four out of twenty-six patients (58.5%) who suffered preoperatively from medical illness of cardiovascular , endocrine-metabolic, central nervous, respiratory, digestive were over sixty years old.Results: None of the patients was dead. The interval between the admission and operative treatment was form 2 to 10 days, with the mean of 5.4 days. The complications during perioperative consisted of cardiac failure in 2 cases, deep venous thrombosis in 3 and coxa varus in 2 . 58 00patients had been followed up from 7~26 months , all of them achieved solid bone union at an average of 3.5 months (range 3~6 months) . There were 32 patients aging from 60 to 87 years. According to the hip functional criterion of Merle D & Aubigne, 83% were rated as excellent and 8% as good. Conclusion: Dynamic hip screw was one of the optimal implants for treatment of intertrochanteric fracture of femur. The operative treatment for intertrochanteric fracture in the elderly gave satisfactory results, provided surgical preparations, effective treatment of preoperative medical conditions and necessary postoperative treatments were fully paid attention to.

关 键 词：135°DHS 股骨粗隆间骨折 围手术期 内固定器 

分 类 号：R683.42[医药卫生—骨科学]