动力髋螺钉治疗股骨粗隆间骨折失败原因分析及对策  

Causes of Dynamic Hip Screw(DHS) Failure in Treating Femoral Intertrochanteric Fracture and Its Salvage

作　　者：周业松[1] 张道前[1] 邵卫东[1] 朱爱军[2] 

机构地区：[1]江苏省淮安市第一人民医院分院骨科,223002 [2]南京医科大学附属淮安第一医院骨科

出　　处：《中国全科医学》2010年第24期2738-2740,共3页Chinese General Practice

摘　　要：目的探讨动力髋螺钉(DHS)治疗股骨粗隆间骨折失败的原因及对策。方法收集2003—2007年用DHS内固定治疗的103例股骨粗隆间骨折患者的资料,总结18例固定失败患者的表现形式,分析其原因。结果 18例固定失败患者的表现形式为:髋内翻畸形8例,髋螺钉切割股骨头、颈5例,螺钉断裂2例,DHS穿出股骨头、颈2例,钢板断裂1例。其中骨折分型EvansⅡ型2例,ⅢA型10例,ⅢB型3例,Ⅳ型3例;骨质Singh指数4级以上者7例,3级以下者11例;术中拉力螺钉置入位置不当者6例;术后3个月内即完全负重行走者12例,3个月后完全负重行走者6例。结论骨折不稳定、骨质疏松、DHS适应证选择不当、拉力螺钉位置不良及术后过早负重等是引起DHS内固定失败的主要原因;重视内固定物的选择、注重内侧骨折块的复位固定、准确放置拉力螺钉,术后避免过早负重可降低内固定失败的发生率。Objective To summarize causes of dynamic hip screw（DHS） failure in treating femoral intertrochanteric fracture and explore the way of salvage.Methods We retrospectively analyzed the clinical data of 103 patients who underwent DHS fixation from 2003 to 2007 in our hospital.Of them,18 treatment failed.The patterns of failures and their reasons were analyzed and the salvage methods were investigated.Results The patterns of these 18 failed treatment included： coxa vara（n=8）,DHS cutting the femoral head and neck（n=5）,fracture of screw（n=2）,cutting out of device through femoral head and neck（n=2）,and plate breakage（n=1）.According to Evans classification,there were two typeⅡ cases,10 type ⅢA cases,3 type ⅢB cases,and 3 type Ⅳcases.According to Singh Index classification,there were 7 cases in or above Index Ⅳ and 11 cases in or under Index Ⅲ.There ware 6 cases were failed due to the wrong fixation locations.Twelve patients regained full weight-bearing walking within 3 months after operation,while 6 patients regained full weight-bearing walking 3 months later after operation.Conclusion The main caused of DHS failures included instability of fracture,osteoporosis,wrongly selected indications,bad location of screw,and premature weight-bearing after operation.Therefore,salvages strategies should pay more attention to the selection of internal fixture,accurate location of screw,and avoiding premature weight-bearing.

关 键 词：股骨粗隆间骨折 骨折固定术 动力髋螺钉 

分 类 号：R683.421[医药卫生—骨科学]