Dynamic hip screw combined with antirotation screw in repair of unstable femoral intertrochanteric fractures

doi:10.3969/j.issn.2095-4344.2014.48.014

Abstract

Abstract:

BACKGROUND: For severe intertrochanteric fracture, the anti-rotation capability is poor, and single dynamic hip screw fixation easily became failure. For example, collapse of the femoral head, femoral neck shortening, unstable hip varus inside small rotor, head and neck rotating, head and neck cutting and nailing, steel nail out and broken steel appeared after fixation. For unstable intertrochanteric fractures, dynamic hip screw fixation has certain limitations.
OBJECTIVE: To explore the effects of dynamic hip screw combined with antirotation screw in repair of unstable femoral intertrochanteric fractures.
METHODS: A total of 96 cases of unstable femoral intertrochanteric fractures were separately subjected to fixation. There were 48 cases in the dynamic hip screw group and 48 cases in the dynamic hip screw combined with antirotation screw group. The surgical time, intraoperative blood loss, exposure time of X-ray, fracture healing time, postoperative Harris hip score and postoperative complications between the two groups were
compared and evaluated.
RESULTS AND CONCLUSION: All the cases were followed up for 18-36 months. The surgical time, intraoperative blood loss, exposure time of X-ray and fracture healing time showed no significant difference between the dynamic hip screw group and dynamic hip screw combined with antirotation screw groups (P > 0.05). Postoperative Harris hip score was higher in the dynamic hip screw combined with antirotation screw group than in the dynamic hip screw group (P < 0.05). The incidence of postoperative complications was significantly higher in the dynamic hip screw group (14%) than that in the dynamic hip screw combined with antirotation screw group (4%; P < 0.05). These data indicated that dynamic hip screw fixation for repair of unstable femoral intertrochanteric fractures showed many complications and high failure rate. However, dynamic hip screw combined with antirotation screw could reconstruct posterior medial femoral structure, make up the shortcomings and deficiencies of dynamic hip screw, and has an important value for the repair of unstable femoral intertrochanteric fracture.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: femur, fractures, bone, internal fixators, fracture healing

CLC Number:

R318

Xin Feng, Zhu Guo-xing, Gu Yang-lin. Dynamic hip screw combined with antirotation screw in repair of unstable femoral intertrochanteric fractures[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(48): 7786-7791.

Figures/Tables 1

2.1 参与者数量分析纳入96例不稳定型股骨转子间骨折患者，按随机数字表法分为动力髋螺钉组及动力髋螺钉联合防旋阻挡钉组，每组48例。术后随访18-36个月，剔除失访者，动力髋螺钉组44例，动力髋螺钉联合防旋阻挡钉组47例。 2.2 基线资料比较两组患者在性别、年龄、侧别、骨折类型、平均体质量及平均身高等方面差异无显著性意义 (P > 0.05)，具有可比性。 2.3 随访结果本组随访时间18-36个月，住院期间无死亡病例，随访中有1例失访，4例死于其他系统疾病。手术时间两组差异无显著性意义(P > 0.05)。术中出血量方面，动力髋螺钉联合防旋阻挡钉组和动力髋螺钉组之间差异无显著性意义(P > 0.05)。X射线暴露次数，动力髋螺钉联合防旋阻挡钉组和动力髋螺钉组之间差异无显著性意义 (P > 0.05)。骨折愈合时间方面，动力髋螺钉联合防旋阻挡钉组和动力髋螺钉组之间差异无显著性意义(P > 0.05)。内固定后髋关节评分(Harris评分)，动力髋螺钉联合防旋阻挡钉组高于动力髋螺钉组(P < 0.05)，详见表1。 2.4 并发症动力髋螺钉组内固定后并发症发生率为14%，其中内固定失败3例，2例为尾帽退出(1例为尾帽退出合并股骨头切割)，伤口感染1例，肺部感染1例，尿路感染1例。动力髋螺钉联合防旋阻挡钉组内固定后12-14周骨折均达骨性愈合，无螺钉退出或钢板断裂及折弯，其并发症发生率为4%，其中肺部感染1例，尿路感染1例。两组患者均无深静脉血栓发生。两组并发症的发生率差异有显著性意义(P < 0.05)，见表2。 2.5 典型病例病例1：女性患者，65岁，右侧不稳定型股骨转子间骨折，予以骨折切开复位动力髋螺钉内固定，内固定后随访22个月，愈合良好(见图1)。病例2：男性患者，63岁，左侧不稳定型股骨转子间骨折，予以骨折切开复位动力髋螺钉联合防旋阻挡钉内固定，内固定后随访27个月，愈合良好(见图2)。"

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