小切口动力髋螺钉治疗高龄股骨转子间骨折_临床医学论文.docVIP

小切口动力髋螺钉治疗高龄股骨转子间骨折_临床医学论文 小切口动力髋螺钉治疗高龄股骨转子间骨折_临床医学论文 【摘要】 探讨应用小切口动力髋螺钉(ＤＨＳ)微创固定治疗高龄股骨转子间骨折的方法及临床效果。［方法］回顾性分析2001年8月～2006年1月应用闭合复位、小切口ＤＨS固定治疗3７例高龄股骨转子间骨折患者，其中男15例，女22例；年龄72～92岁，平均81.5岁。在C型臂X线机监视下，先将1～2枚克氏针经皮通过大转子打入股骨头上部。另将1枚导针按135°颈干角打入股骨头中央，在导针下做一长约4～５.5 cm纵切口，经导针拧入粗拉力螺纹钉。拔出导针将带套管接骨板沿肌层下插入，并将接骨板的套管套入螺纹钉的尾端。［结果］手术时间40～75 min，平均60 min。 术中平均出血55 ml。术后与术前血红蛋白值比较无明显变化。37例均获11～18个月随访，骨折愈合时间10～15周。轻度髋内翻2例，无切口感染、内固定失效及旋转畸形。按董纪元疗效评定标准，优良率94.6％。［结论］小切口DHS微创技术具有手术时间短、出血少、创伤小、并发症少、康复快的特点，是治疗高龄股骨转子间骨折较理想的方法。 【关键词】 股骨骨折 老年人 骨折固定术 动力髋螺钉 微创 Abstract：［Objective］To explore the surgical technique and clinical results of minimally invasive incision dynamic hip screws (DHS) in treatment of intertrochanteric fractures in the elderly.［Method］From August 2001 to January 2006,37 old cases (15 males and 22 females, aged from 72 years to 92 years, mean 81.5 years) with intertrochanteric fractures were treated with closed reduction and DＨS using minimally invasive technique in our hospital. The procedure included following and critical steps:1～2 kserted into the upper part of the femoral head through great trochanter percutaneously after operation. A guide wire was inserted into the center of the femoral head according to 135° collodiaphyseal angle; then, a small incision (4～5.5 cm) was made and along the guide wire for inserting a screw into the femoral head. The guide wire was removed and the side plate was slipped under the soft tissue into to tightly contact the lateral surface of femur, and followed by the side plate barrel being seated on the screw.［Result］The operation time was 40～75 minutes (average 60 minutes) The mean amount of blood loss in, operation was 55 ml. The mean amount of hemoaleh:in showed no significant difference between postoperation and preoperation. The followingup period averaged 15 months (１１～18 months) The clinical hone healing lasted for 10～15 weeks. Two cases had mild coxa vara, there were no incision infection, fixation failure or lower extremity rotatory de