经皮椎体后凸成形术论文.doc

植骨在DHS固定治疗股骨粗隆间骨折中的作用 作者：徐锋，吕建元，洪嵘，蒋铭，吴晓峰，程翔 作者单位：南京中医药大学附属昆山中医院骨科，江苏 昆山 【摘要】 目的 探讨植骨在动力髋螺钉(dynamic hip screw，DHS)内固定治疗股骨粗隆间骨折中的临床作用。方法 2004～2007年我院收治60 例Evans分型Ⅰ～Ⅳ型股骨粗隆间骨折病例，采用动力髋螺钉治疗股骨粗隆间骨折。手术分两组，术中不植骨组30 例，采用常规实心三联扩孔器扩孔DHS内固定；术中植骨组30 例，采用我院自行研制的DHS空心扩孔器扩孔，取骨、植骨，DHS内固定，术后进行随访比较。结果 采用黄公怡［1］髋关节功能评定标准进行评价，不植骨组30 例，优14 例，良9 例，可4 例，差3 例，髋内翻7 例，术后螺钉切割拔出2 例，钢板断裂1 例，骨不连2 例，优良率76.7％。植骨组30 例，优18 例，良9 例，可2 例，差1 例，髋内翻3 例，术后髋螺钉切割拔出1 例，无钢板、螺钉断裂，无骨不连，优良率90.0％。结论 DHS内固定治疗股骨粗隆间骨折时，预防性植骨可加速骨折愈合，迅速重建内侧支持结构，减少髋内翻及相关并发症。 【关键词】 股骨粗隆间骨折；动力髋螺钉内固定；植骨 The Clinical Application of Bone Graft in the Operation of Intertrchanteric Femur Fracture by DHS XU Feng，LV Jianyuan，Hong Rong，et al (Department of Orthopaedics，Kunshan Hospital Of Nanjing Traditional Chinese Medicine，Kunshan 215300，China) Abstract：Objective To discuss the clinical application of bone graft in the operation of Dynamic Hip Screw(DHS)in the intertrchanteric femur fractures(IFF).Methods From 2004 to 2007，60 cases of IFF in type Ⅰ～Ⅳ according to the Evans classification were treated by DHS.The cases were divided into two groups.The method of traditional triad solid reamer was adopt to treat 30 cases without bone graft and hollow reamer by developing independently to the other 30 cases with bone graft.Results Acording to the standards of hip function evaluation of Huang Gongyi.The group without bone graft：excellent for 14 cases，good for 9 cases，fair for 4 cases and poor for 3 cases.There were 7 cases of coxa vara，2 cases of hip screw cutsout，1 case of collapse of internal fixation and 2 cases of fracture nonunion.76.7％showed excellent or good result.The group with bone graft：excellent for 18 cases，good for 9 cases，fair for 2 cases and poor for 1 case.There were 3 cases of coxa vara，1 cases of hip screw cutsout and no case of collapse of internal fixation or fracture nonunion.90.0％showed excellent or good result.Conclusion The application of preventive bone graft in the operation of IFF by DHS can hasten th