动力髋螺钉切割效应的影响因素分析_临床医学论文.docVIP

动力髋螺钉切割效应的影响因素分析_临床医学论文 动力髋螺钉切割效应的影响因素分析_临床医学论文 作者：张涛，韩冠生，刘涛，陈辉 【摘要】 目的：分析动力髋螺钉切割效应的影响因素。方法：将我院收治的股骨粗隆间骨折的39例患者随机进行切开复位、动力髋螺钉内固定治疗。有3例因没有足够的X线片供对比观察而被排除，36例纳入研究。观察手术前后X线片，研究骨折分型、颈干角的复位以及髋螺钉位置对股骨头发生切割的影响。结果：随访期为术后3～12个月，平均7.5个月，36例均得到随访。8例为稳定型骨折，28例不稳定型骨折，发生螺钉切割的3例均为不稳定型骨折，骨折类型与手术后的切割效应无显著相关性(Pgt;0.05)。26例为颈干角理想复位，10例为颈干角非理想复位，失败率的差异具有统计学意义(0.05)。A组中有3枚螺钉因切割股骨头而失效，B组没有螺钉切割,两组之间的差异具有显著统计学意义(0.05)。结论：颈干角的恢复和髋螺钉的植入位置影响了股骨头切割的发生率。不同类型的粗隆间骨折采用动力髋螺钉内固定治疗时，髋螺钉切割的发生率没有明显差异。 【关键词】 转子间骨折; 内固定; 动力髋螺钉 　　[Abstract] Objective： To analyze the influencing factors on dynamic hip screw(DHS) cuttingwed to determine the relationship of classification of fracture, reduction of collodiaphyseal angle and the position of the screw within the femoral head.AP and lateral radiographs taken preoperatively and postoperatively were observed. Results: All cases were followed up from 3 months to 12 months(7.5 months in average). 8 fractures were classified as stable fracture and 28 as unstable fracture. The failure rate was similar between the 2 groups(Pgt;0.05). Collodiaphyseal angle of 26 cases were completely reduced and 10 were incompletely reduced. There was significant difference in the number of cuttingout between the 2 groups(0.05). 3 screws placed in A group had cut out of the femoral head and none in B group.There was a statistical difference between the 2 groups(0.05). Conclusion: Collodiaphyseal angle reduction and implant placement affect the rate of cutting out. A central or inferior position on the AP view is best. The cuttingout rates show no significant differences when patients suffering intertrochanteric fractures classified various types were treated with DHS implant. 　　[Key words] intertrochanteric fracture; internal fixation; dynamic hip screw 　　股骨粗隆间骨折好发于老年人，随着我国人口逐渐进入老龄化，该骨折的发生率逐年上升。大多数学者认为，手术治疗为首选。内固定材料主要为髓内和髓外两种固定系统，动力髋螺钉因具有对骨折端滑动加压的作用，而作为以钉板系统进行髓外固定的经典代表,在长期临床应用过程中取得了良好的效果[1]。然而因为髋螺钉对股骨头的切割效应，动力髋螺钉内固定仍有一定的失败率,临床医生通常依靠观察普通X线片来衡量内植物的初始稳定性。本研究通过对骨折固定后的稳定性进行回顾性分析，探讨股骨颈干角的复