髓内增强块动力髋螺钉固定老年股骨粗隆间骨折△

Dynamic hip screw with intramedullary reinforcement pad for fixation of femoral intertrochanteric fractures in elderly

摘要:

[目的] 探讨股骨距髓内增强垫块动力髋螺钉 （dynamic hip screw, DHS） 治疗老年股骨粗隆骨折的临床疗效。[方法] 2019 年 4 月—2022 年 12 月，28 例老年股骨粗隆间骨折患者应用髓内增强块动力髋螺钉固定手术治疗，评价临床及影像结果。[结果]患者均顺利完成手术。手术时间平均（60.2±8.4）min、切口长度平均（12.5±3.2）cm、术中失血量平均（110.3± 25.2）ml、术中透视次数平均（16.5±4.3）次、患者下地时间平均（3.2±1.1）d。所有患者均获得有效随访，与术后 1、3 个月相比，末次随访患者的 VAS 评分 [(3.2±1.1), (2.6±1.2), (1.3±0.8), P＜0.001] 显著降低，Harris 评分 [(68.6±8.5), (76.3±4.2), (86.6±5.7), P＜ 0.001]、伸屈 ROM [(82.5±10.3)°, (101.5±9.6)°, (120.2±5.1)°, P＜0.001] 和内-外旋 ROM [(50.2±6.4)°, (61.2±5.6)°, (80.2±7.41)°, P＜ 0.001] 显著增加。影像方面，与术后 1、3 个月相比，末次随访时，股骨颈干角、头颈长度、顶尖距均无显著变化（P＞0.05）；末次随访时所有患者骨折均骨性愈合。[结论]股骨距髓内增强垫块动力髋螺钉加强股骨上段内侧力学支撑，有利于患者早期负重行走，减少并发症发生率，可作为临床治疗骨质疏松性老年股骨粗隆间骨折的一种选择。

Abstract:

[Objective] To investigate the clinical efficacy of dynamic hip screw (DHS) with intramedullary reinforcement pad for fixation of femoral intertrochanteric fractures in elderly. [Methods] From April 2019 to December 2022, 28 elderly patients with intertrochanteric fracture of femur were treated with DHS with intramedullary reinforcement pad. The clinical and imaging documents were evaluated. [Results] All patients had the fractures reduced and fixed successfully, with the average operation time of (60.2±8.4) min, the average incision length of (12.5±3.2) cm, the average intraoperative blood loss of (110.3±25.2) ml, the average intraoperative fluoroscopy times of (16.5±4.3) times, and the average bed rest time of (3.2±1.1) days, and were effectively followed up. As time went 1 month, 3 months after surgery and the latest follow up, the VAS score significantly decreased [(3.2±1.1), (2.6±1.2), (1.3±0.8), P＜0.001], while the Harris score [(68.6±8.5), (76.3± 4.2), (86.6±5.7), P＜0.001], flexion-extension range of motion (ROM) [(82.5±10.3)°, (101.5±9.6)°, (120.2±5.1)°, P＜0.001] and internal-external rotation ROM [(50.2±6.4)°, (61.2±5.6)°, (80.2±7.41)°, P＜0.001] increased significantly. Regarding to imaging, there were no significant changes in femoral neck shaft angle, head and neck length and tip-apex distance at the last follow-up compared with those 1 and 3 months after surgery (P＞0.05). Bone healing was observed in all patients at the last follow-up. [Conclusion] The dynamic hip screw (DHS) with intramedullary reinforcement pad enhances mechanical support of calcar femorale, facilitate early weightbearing walking, reduce the incidence of complications, and might be a good choice for osteoporotic femoral intertrochanteric fractures in the elderly.