小切口动力髋螺钉治疗高龄股骨转子间骨折

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1、小切口动力髋螺钉治疗高龄股骨转子间骨折【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4～５.5cm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

2、尾端。［结果］手术时间40～75min，平均60min。术中平均出血55ml。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］Toexplorethesurgicaltechniqueandcl

3、inicalresultsofminimallyinvasiveincisiondynamichipscrews(DHS)intreatmentofintertrochantericfracturesintheelderly.［Method］FromAugust2001toJanuary2006,37oldcases11(15malesand22females,agedfrom72yearsto92years,mean81.5years)withintertrochantericfracturesweretreatedwithclo

4、sedreductionandDＨSusingminimallyinvasivetechniqueinourhospital.Theprocedureincludedfollowingandcriticalsteps:1～2kwireswasinsertedintotheupperpartofthefemoralheadthroughgreattrochanterpercutaneouslyafteroperation.Aguidewirewasinsertedintothecenterofthefemoralheadaccord

5、ingto135°collodiaphysealangle;then,asmallincision(4～5.5cm)wasmadeandalongtheguidewireforinsertingascrewintothefemoralhead.Theguidewirewasremovedandthesideplatewasslippedunderthesofttissueintototightlycontactthelateralsurfaceoffemur,andfollowedbythesideplatebarrelbeings

6、eatedonthescrew.［Result］Theoperationtimewas40～75minutes(average60minutes)Themeanamountofbloodlossin,operationwas55ml.Themeanamountofhemoaleh:inshowednosignificantdifferencebetweenpostoperationandpreoperation.Thefollowingupperiodaveraged15months(１１～18months)Theclinical

7、honehealinglastedfor10～15weeks.Twocaseshadmildcoxavara,therewerenoincisioninfection,fixationfailureorlowerextremityrotatorydeformity.Theexcellentrate　ofjointfunctionwas94.6%accordingtoDONG'sassaystandard.11［Conclusion］MinimallyinvasiveincisionDＨShastheadvantagesofshort

8、eroperationtime,lessbloodloss,littletrauma,lesscomplicationsandquickfunctionalrecoveryandisaneffectiveandsafemethodfo