DHS系统置入质量控制在老年股骨粗降间骨折治疗中的应用.docVIP

DHS系统置入质量控制在老年股骨粗降间骨折治疗中的应用 　　【摘 要】目的：探讨DHS系统置入质量控制提高DHS置入准确性。方法：选择2009年3月至2012年3月，采用DHS系统内固定31例，Evans分型，I型：17例，II型14例。多学科对患者原有基础疾病进行明确诊断，专科治疗，基础疾病控制平稳，健康状况明显改善后，尽早手术。术前股骨髁上骨牵引复位，完全纠正短缩、旋转畸形，颈干角与对侧相似，并适当“过牵”。将DHS系统置入：主钉距离股骨头边缘5-10mm，透视正侧位在股骨颈内中置，侧钢板位于股骨近端外侧中线，贴合良好的标准位置。结果：23例符合DHS内固定者，置入标准位置，4例主钉选择偏短，DHS主钉距离股骨头边缘10mm以上，其中，3例在股骨颈正侧位，主钉未能中置，选择较短主钉。1例置入偏短主钉。2例DHS侧钢板由于进钉点偏前，侧钢板未置入股骨近端外侧中线。1例术后主钉从股骨颈切出，术后8天进行翻修手术。30例术后1、3、6、12月门诊骨盆正位，股骨颈正轴位正示，获得骨性愈合，无主钉断钉，断板，1例主钉切出。结论：导针、主钉置入质量控制，是DHS系统置入质量控制的关键。 　　【中图分类号】R683.42 【文献标识码】A 【文章编号】1004-7484（2013）05-0750-02 　　Application of Quality Control in Treatment of femoral intertrochanteric fracture in the elderly with Insertion of DHS system 　　【Abstract】Objective：To investigate the quality control in the DHS placement to improve the accuracy of the DHS placement. Methods：From March 2009 to March 2012， 31 cases were fixed with the DHS systems， according Evans classification， type I： 17 cases， and 14 cases of Type II. The patients were operated as soon as possible after treated against the original diseases. The femoral epicondylus tractions were performed preoperatively to correct the shortening and rotational deformity completely and to make the neck shaft angle similar to the contralateral and to keep appropriate over-traction stations. The DHS systems were placed： the main nail was placed about 5-10mm from the head edge of femoral and were sure in the middle of the neck of the femoral with fluoroscopy， and the plate was placed in the standard position on the middle line of the proximal of the femoral. Result：The nails were in the standard position in 23 cases， and were too short in 4 cases with the distance over 10mm from the edge of the head of the femoral. The nails were not in the standard position and too short in 3 cases， and was too short in 1 case. The plates of DHS were not on the middle line of the proximal of the femoral because the start points were in the front of the standard point. The nail was out of the neck