CAJ | 학술논문

背景：临床上股骨转子间骨折可呈不同程度的粉碎状态，其内侧皮质往往缺乏连续性，压陷、小转子移位等因素常常导致股骨距的生物力学遭到不同程度破坏，此情况下对骨折类型进行详细分型，严格掌握动力髋螺钉适应证是极其重要的。目的：进一步剖析动力髋螺钉置入内固定修复股骨转子间骨折失效的原因。方法：对兰州大学第二医院康泰分院骨科2004年3月至2013年12月收治的应用动力髋螺钉置入内固定修复股骨转子间骨折的82例患者资料进行回顾性分析，探讨内固定失效的原因及预防方法。结果与结论：所有患者随访4-48个月，骨折愈合时间12-38周，共12例固定失效，发生率为15%。在12例内固定失效病例中，髋螺钉切割致穿出股骨头颈7例，其中合并股骨头坏死1例；加压钉滑出套筒1例，螺钉拔出、断裂、钢板松动3例，钢板断裂1例。EvansⅡ型1例(8%)，Ⅲ型3例(25%)，Ⅳ型5例(42%)，Ⅴ型3例(25%)。小转子未完全复位5例，占42%，尖顶距>25 mm 7例，占58%，早期负重(内固定后3周)1例，占8%。提示适应证的选择、骨折复位后的稳定程度，内植物安放位置的精准度及内固定后不合理的锻炼均可致动力髋螺钉内固定失效，而术前认真全面的分析、术中精准操作及术后合理的功能锻炼是保证内固定成功的关键。
배경：림상상고골전자간골절가정불동정도적분쇄상태，기내측피질왕왕결핍련속성，압함、소전자이위등인소상상도치고골거적생물역학조도불동정도파배，차정황하대골절류형진행상세분형，엄격장악동력관라정괄응증시겁기중요적。목적：진일보부석동력관라정치입내고정수복고골전자간골절실효적원인。방법：대란주대학제이의원강태분원골과2004년3월지2013년12월수치적응용동력관라정치입내고정수복고골전자간골절적82례환자자료진행회고성분석，탐토내고정실효적원인급예방방법。결과여결론：소유환자수방4-48개월，골절유합시간12-38주，공12례고정실효，발생솔위15%。재12례내고정실효병례중，관라정절할치천출고골두경7례，기중합병고골두배사1례；가압정활출투통1례，라정발출、단렬、강판송동3례，강판단렬1례。EvansⅡ형1례(8%)，Ⅲ형3례(25%)，Ⅳ형5례(42%)，Ⅴ형3례(25%)。소전자미완전복위5례，점42%，첨정거>25 mm 7례，점58%，조기부중(내고정후3주)1례，점8%。제시괄응증적선택、골절복위후적은정정도，내식물안방위치적정준도급내고정후불합리적단련균가치동력관라정내고정실효，이술전인진전면적분석、술중정준조작급술후합리적공능단련시보증내고정성공적관건。
BACKGROUND:Intertrochanteric fracture showed shattered state of different degrees in the clinic. The medial cortex is often a lack of continuity. Indentation and lesser trochanter displacement often cause destruction of biomechanics of femoral calcar to different degrees. Under this condition, it is very important to perform detailed classification of fractures and to strictly master indication of dynamic hip screw. OBJECTIVE:To further analyze the reasons for failure of internal fixation with dynamic hip screw for intertrochanteric fracture. METHODS:Data of 82 patients with intertrochanteric fracture repaired by internal fixation with dynamic hip screw, who were treated at the Department of Orthopedics, Kangtai Branch of the Second Hospital of Lanzhou University from March 2004 to December 2013, were retrospectively analyzed. The reason for failure of internal fixation and prevention method were explored. RESULTS AND CONCLUSION:Al patients were fol owed up for 4-48 months. Time of fracture healing was 12-38 weeks. Fixation failure was found in 12 cases, with an incidence of 15%. Of 12 failure cases, 7 cases affected hip screw cutting out femoral head neck (including 1 case combined with avascular necrosis of the femoral head), 1 case suffered from compression screw slipping out of the tube, 3 cases experienced screw pul ing out and breaking, plate loosening, and 1 case affected steel plate breakage. There were 1 case of Evans II type (8%), 3 cases of type III (25%), 5 cases of type IV (42%), and 3 cases of type V (25%). Lesser trochanter was not completely reset in 5 cases (42%). There were tip-apex distance>25 mm in 7 cases (58%) and early weight loading (3 weeks after fixation) in 1 case (8%). These data confirmed that the selection of indications, the degree of stability after reduction, accuracy of implant position and postoperative unreasonable exercise wil cause fixation failure of dynamic hip screw. Preoperative careful and comprehensive analysis, intraoperative precise operation and postoperative reasonable functional exercise are the keys to ensure success of fixation.