DHS治疗股骨粗隆间骨折若干问题及对策.docVIP

DHS治疗股骨粗隆间骨折若干问题及对策 　【摘要】 目的 探讨DHS治疗股骨粗隆间骨折的临床效果、适应证、存在的问题及对策。方法 分析我院自2002年10月至2006年10月行DHS内固定治疗股骨粗隆间骨折56 例，男24 例，女32 例，年龄50～92 岁，平均76.2 岁。结果 术中出现拉力螺钉松动2 例，内后侧骨皮质缺损14 例，股骨头后倒旋转2 例。术后半年出现1 例切割，螺丝钉穿出股骨头2 例，DHS拆除后再骨折1 例，随访0.5～3年，48 例恢复正常行走，术后优良率85.71％。结论 重视手术适应证的选择，术中加强手术技巧，注重小粗隆的复位，结合中空螺钉，应用磷酸钙骨水泥，植骨防止螺丝松动，加强DHS拆除后的管理均可获得良好的效果。 【关键词】 DHS 粗隆间骨折 内固定 　　The Related Problems and Management in the Treatment of Intertrochanteric Fractures of Femur with DHS 　 Abstract：Objective To exploer the clinical outcomes，operation indiction and the related problems of dynamic hip screw(DHS) in the treatment intertrochanteric fractures of femur.Methods Between October 2002 and October 2006，56 cases of intertrochanteric fractures of femur were treated with DHS.There were 24 males and 32 females，and the average age of which was 76.2 years ranging from 50 to 92 years.Results The patients were followed up from 6 months to 3 years.48 patients recovered good walking，the excellent rate of the function was 85.71％.The complications of operating included：2 had lag screw loose，14 had a significant cortical defect in posteromedially and 2 had femoral head rotation and posterior sag.The complications of postoperation included：1 had cutting out，2 had protruding screw，1 had refracture after remove DHS.Conclusion It can be have good effect through the choice of operation indiction strictly，familiar manipulation，reduction of lesser trochanter satisfactorilv.the use of the holl screw and the use of calcium phosphate cement，preventing screw loose by bone graft and strength the management after removing DHS. Key words：DHS；intertrochanteric fractures of femur；internal fixation 随着人口的老龄化和骨质疏松的日益严重，股骨粗隆间骨折发生率逐年上升。我院自2002年10月至2006年10月行DHS内固定治疗股骨粗隆间骨折56 例，取得满意效果，现报道如下。 　　1 临床资料 　　1.1 一般资料 　　本组共56 例，男24 例，女32 例；年龄50～92 岁，平均76.2 岁。左侧26 例，右侧29 例，1 例为双侧。合并心脑血管疾病、呼吸系统疾病、内分泌疾病及其他内科疾病43 例，均得到相应处理后手术。按Evans分型，Ⅰ型4 例，Ⅱ型8 例，Ⅲ型17 例，Ⅳ型27 例。术前病程3～14 d，平均6～7 d，输血0～1 200 mL，平均400 mL。 　　1.2 手术方法 　　入院后行皮肤牵引或骨牵引，完善术前检查，治疗内科疾病。