摘要
目的:分析动力髋螺钉内固定治疗股骨转子间骨折失败原因,提高动力髋螺钉内固定治疗的成功率。方法:回顾分析我院2009年-2012年期间采用动力髋螺钉内固定治疗142例股骨转子间骨折的病例资料,筛选失败病例,分析失败的表现形式,统计失败比例,分析DHS失败原因与影响因素。结果:①共计出现18例内固定失败,失败比例为12.68%,表现为加压钉穿出股骨头4例(22.22%)、加压钉切割股骨头颈3例(16.67%)、加压钉短致再次骨折1例(5.56%)、加压钉位置不良6例(33.33%)、螺钉松动或套接钢板断裂1例(5.56%)、加压钉切割股骨头颈伴髋内翻2例(11.11%)、髋内翻1例(5.56%);②动力髋螺钉内固定治疗失败影响因素包括骨质疏松、骨折分型、切出指数,有无骨质疏松的内固定失败率分别为23.53%比9.26%,稳定型与不稳定型骨折的失败率分别为5.26%比17.65%,≥100与<100的切出指数的失败率分别为68.75%比5.56%,≥4和<4singh指数的的失败率分别为4.81%比34.21%,各因素水平间差异明显,尤其是不同切出指数水平差异更加显著,不同骨折分型内固定失败率差异不明显。结论:动力髋螺钉内固定治疗股骨转子间骨折的临床疗效良好,但应掌握应用适应证,正确评估手术风险性与影响因素,尤其是骨质量评估,做好围手术期的全程质量控制,精确螺钉在股骨头内的合理位置,才能提高手术成功率。
Objective：To analyze the failure causes of DHS internal fixation in the treatment of intertrochanteric fractures and to improve success rate of DHS therapy. Methods.. The clinical data of 142 intertrochanteric fractures from 2009 to 2012 were studied retrospectively to analyze the failure cause and influencing factors of DHS internal fixation. Results：① There were 18 cases of internal fixation failure and the failure rate was 12.68%. Including 4 cases of femoral head perforation of screw（22.22 %）, 3 cases of screw cutting femoral neck（16.67 %）, 1 case of refracture（5.56 % ） , 3 cases of misplacement of screw（33.33%）, 1 case of plate broken and screw loosen（5.56%） ,2 cases of screw cutting femoral neck accompanied by hip varus（11.11% ） and 1 case of hip varus（5.56 % ）. ②The influencing factors for failure of DHS internal fixation are oste- oporosis, fracture patterns and cutting-out index. The failure rates in osteoporosis patients and nonosteoporosis patients were 23.53% and 9.26% respectively and the difference was significant. The failure rates in stable type and unstable type were 5.26% and 17.65% respectively and the difference was not significant. The failure rates in patients with cutting-out index≥100 and that 〉100 were 68.75% and 5.56% respectively and the difference was significant. The failure rates in pa- tients with Singh Index ≥4 and that 〈4 were 4.81% and 34.21% respectively and the difference was significant. Conclu- sion..The dynamic hip screw fixation is an effective method in the treatment of intertrochanteric fractures. It shows that if only we severely select the indication, make a proper evaluation of operative risk and influencing factors, especially the as- sessment of bone quality, make a good job of the quality control in the perioperative period and confirm the accurate posi- tion of the screw in the femoral head, it will improve success rate of operation.
出处
《中国中医骨伤科杂志》
CAS
2013年第8期26-27,30,共3页
Chinese Journal of Traditional Medical Traumatology & Orthopedics
关键词
股骨转子间骨折
内固定
失败
原因
Intertrochanteric fracture
Internal fixation
Failure
Reason
