改良DHS在股骨转子间骨折的应用.docVIP

改良DHS股骨骨折的 陈冰 贾万贵 （浙江省余姚中医院，浙江 余姚 315400） [摘要] 目的 探讨改良DHSdynamic hip screw,DHS)治疗股骨粗隆间骨折的手术特点和疗效。方法 回顾分析2008-2011年用DHS和改良DHS治疗股骨粗隆间骨折105例，其中DHS组58例，改良DHS组57例，对2组患者的、髋关节功能 Harris评分等情况进行比较。结果 经过15-18月，平均16.月随访，骨折基本愈合或临床愈合，患者已自理生活，局部无痛关节活动良好结论 改良DHS在治疗股骨粗隆间骨折在疗效和并发症方面有明显优势，尤其对骨折严重粉碎、骨质疏松患者，更有利于骨折愈合和功能恢复。 [关键词] 髋骨折 股骨骨折 临床对照试验 外科手术 骨折固定术 raditional Chinese hospital, Yuyao 315400,Zhejiang,China ABSTRACT Objective:To investigate the characteristic of modified DHS and the curative effect in the treatment of the intertrochanteric fracture.Methods:105 patients with in-tertrochanteric fracture from 2008 to 2011 were retrospectively analyzed.Among them,58 patients were treated with DHS and 57 patients were treated with modified DHS. The pain, malformation, and hip joint function were compared between two groups.Results: All patients were followed up for 15 to 18 months （means months）All fractures were bone healing except one patients was died． The Passive Range of Motion were compared between two groups,The malformation and hip joint function of modified DHS group was taller than that of DHS group(P＜Conclusion: Modified DHS has several advantages on wider indications,stronger holding power,early forepart movement time,ewer complications,which is a good choice for osteoporotic intertrochanteric fracture． KEY WORDS Fractures fixation; Femoral Fractures; internal;Controlled clinical trials; operative; Surg股骨粗隆骨折随着龄社会，股骨粗隆骨折发生率逐年上升早期手术治疗患者早期下床活动，减少因长期卧床引起的并发症，降低死亡率[1]。DHS在治疗股骨粗隆间骨折中疗效肯定，已广泛应用，但其抗旋性能较差，对于复杂股骨粗隆间骨折，我们用2枚主钉的改良DHS治疗股骨粗隆间骨折，取得了肯定的疗效。 1 资料105例中男89例，女26例；年龄最小6，最大岁，平均岁。损伤原因：骑车摔伤32例，走路摔伤70例，车祸3例。合并症：糖尿病例，骨质疏松例，合并膝关节功能受限1例，合并脑血栓1例，其他2例；根据EvansⅠ分型:Ⅰ型30例；Ⅱ型31例，Ⅲ型33例，Ⅳ型11例。 表1组资料比较组别 例数 年龄（岁） 性别（例） 男/女 Evans I型（例） I型 Ⅱ型 Ⅲ型 Ⅳ型 改良DHS组 57 68.51±8.79 42/15 13 21 16 7 DHS组 58 68.25±9.13 47/11 17 20 17 4 检验值 t=0.234 x2=0.063 x2=0.077 P值 ＞0.05 ＞0.05 ＞0.05 ，患者仰卧位，，C臂机监视下闭合复位，取髋外侧直切口，从大粗隆顶点上方1cm至其下方10cm，依次切开各层，显露大粗隆，在大粗隆顶点下方1.5cm、2.5cm处分别导针定位，沿导针开孔，旋入改良DHS的2枚主钉，依