摘要
[目的]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.
[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 k-wires was inserted 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 deformity. The excellent rate of joint function was 94.6% according to DONG＇s assay standard. [ Conclusion] Minimally invasive incision DHS has the advant, tages of shorter operation time, less blood loss, little trauma, less complications and quick functional recovery and is an effective and safe method for treatment of femoral intertrechanteric fractures in the elderly.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2007年第16期1227-1229,共3页
Orthopedic Journal of China
关键词
股骨骨折
老年人
骨折固定术
动力髋螺钉
微创
femoral fractures, aged
fracture internal fixation
dynamic hip screw
minimally invasive
作者简介
张海波（1966-）,男,河南人,副主任医师,研究方向：脊柱外科及创伤骨科,（电话）0378-5671088
