摘要
目的总结应用微创动力髋螺钉(minimally invasive dynamic hip screws,MIDHS)治疗老年股骨转子间骨折的疗效。方法2006年4月-2008年3月,应用MIDHS治疗老年股骨转子间骨折49例。男22例,女27例;年龄65～78岁,平均70.2岁。致伤原因:交通伤7例,高处坠落伤3例,跌伤39例。受伤至手术时间2～12d,平均5.5d。骨折按Evans分型:稳定型(Ⅰ、Ⅱ型)28例(57.1%),不稳定型(Ⅲ、Ⅳ型)21例(42.9%)。Singh指数≤3者35例(71.4%),合并骨质疏松。手术于C臂X线机引导下应用骨科牵引床行骨折闭合复位后MIDHS固定,不稳定型骨折均同时于MIDHS头钉近侧植入1枚防旋松质骨螺钉。结果患者平均手术时间65.2min,平均失血量189.3mL,均未输血。术后骨折复位均满意,拉力螺钉位置满意者39例(79.6%)。住院时间3～12d,平均5.8d。术后切口均Ⅰ期愈合,无切口感染、下肢深静脉血栓、肺栓塞发生。49例均获随访,随访时间12～30个月,平均19.8个月。47例患者骨折愈合,愈合时间12～16周,平均13.1周。术后1年髋关节功能Harris评分为75～95分,平均90.8分。2例EvansⅣ型骨折患者于术后6～8周出现内固定失败、骨折不愈合,分别行全髋关节置换和人工股骨头置换;余患者无再骨折、股骨头坏死及手术相关死亡等严重并发症发生。结论MIDHS固定治疗老年股骨转子间骨折手术操作简便、安全、有效。
Objective To evaluate the effect of minimally invasive dynamic hi p screws （MIDHS） in treating aged intertrochanteric fractures. Methods From April 2006 to March 2008, 49 aged patients with intertrochanteric fractures were treated with MIDHS. There were 22 males and 27 females, aged 65-78 years （average 70.2 years）. Frature was caused by traffic accident in 7 cases, by falling from height in 3 cases, and by injury from fall in 39 cases. The time from injury to operation was 2-12 days （average 5.5 days）. According to Evans classification, there were 28 cases of types Ⅰ, Ⅱ（stable fracture） and 21 cases of types Ⅲ, Ⅳ （unstable fracture）. If the Singh index 3 was defined as osteoporosis, the osteoporotic rate was 71.4% （35/49）. All patients were on a radiolucent fracture traction table and their fractures had satisfactory closed reduction. After the guide wire was inserted and reamed under fluoroscopy, the lag screw and side plate were introduced through the small incision. In all unstable fractures, an additional, antirotational and large cancellous bone screw was used cranial to the DHS. Results The average operation time was 65.2 minutes. The average blood loss was 189.3 mL. All patients had satisfactory reduction and 79.6% （39/49） had adequate lag screw positions. The average postoperative hospitalization days was 5.8 days （3-12 days）. All incision healed at stage I. There was no postoperative complications. Forty-nine patients were followed up 12 to 30 months （average 19.8 months）. Fractures healed within 16 weeks in 47 patients and the average healing time was 13.1 weeks （12-16 weeks）. The average Harris scoring was 90.8 （75-95）. Implant failure and nonunion occurred in 2 cases, no serious complication occurred in other patients. Conclusion The MIDHS is a simple, safe and effective method for treatment of aged intertrochanteric fractures.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2009年第9期1071-1074,共4页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
股骨转子间骨折
微创动力髋螺钉
内固定
老年
Intertrochanteric fracture patients Minimally invasive dynamic hip screw Internal fixation Aged
