Therapeutic effect of dynamic hip screw in the treatment of 18 cases of intertrochanteric fracture
Therapeutic effect of dynamic hip screw in the treatment of intertrochanteric fractures of the femur He Qixin Chen Yuchang Liu Yongqing Song Nengliang Li Jiefeng Liao Suibo (Department of Orthopaedics, Taiping People's Hospital, Dongguan, Guangdong 523900, China) Objective: To investigate the clinical significance of dynamic hip screw (DHS) in the treatment of intertrochanteric fractures of the femur . Methods: 18 cases of intertrochanteric fractures were treated with surgery. All patients underwent DHS fixation. RESULTS: After 6-20 months of follow-up, 17 patients were painless and the function returned to normal or near normal. Conclusion: DHS is an effective internal fixation material for the treatment of intertrochanteric fractures of the femur. It is a fixed fixation and is not easy to have hip varus or external rotation deformity.
In order to improve the early rehabilitation ability of patients with intertrochanteric fractures, from August 2000 to April 2002, 18 patients with intertrochanteric fractures were treated with dynamic hip screw (DHS). The report is as follows.
1 Materials and Methods 1.1 General Information This group of 12 males and 6 females. In the age group, 13 cases (72.2%) had 8 cases on the left side and 10 cases on the right side. Causes of injury: 4 cases of falling from high places, 10 cases of falls, and 4 cases of traffic accidents. The group had 8 cases of cardiovascular disease, 4 cases of respiratory diseases, and 2 cases of diabetes. The fracture type was classified into 3 cases according to Evans standard, 7 cases of type I, 4 cases of type IV, and 4 cases of type V. Fractures were performed for 1 to 10 days, with an average of 48 days.
1.2 Methods This group of surgery applied DHS () special equipment, and with the help of C-arm X-ray machine, elderly patients with multi-functional ECG monitor monitoring. The operation was performed with epidural anesthesia, the affected side of the lumbar buttocks pad was used as a flat pillow, and the torso and the table were made into 30. Take the Watson-Jones incision, and use the c-arm x-ray machine to complete the fracture. After seeing the satisfaction, use a few K. The needles are temporarily fixed and these needle positions do not affect the final position of the inner fixture. At the 2cm lateral cortical bone at the apex of the greater trochanter, a DHS angle guide with a *T*-type handle is used to drill the guide needle into the femoral head. When drilling, the *T*-type handle should be lowered backward by about 15. The needle tip is from the stock. The bone cartilage surface is preferably 0.5 ~ 1.0cm. After satisfactory fluoroscopy, ream the hole with DHS triple reamer, then screw into DHS. Place the DHS plate with sleeve, fix it on the outside of the femur with the bone holder, and fix the plate with screws. Pull out the guide pin, tighten the DHS compression screw, then remove the temporarily fixed Kirschner wire, rinse the wound, leave the negative pressure drainage tube, and suture the incision layer by layer. Postoperative limb abduction 30. and traction with the lower limb traction belt for 3 weeks, weight 2 - 3kg. 2 weeks after wound wound removal; 3 weeks after removal of traction, exercise hip and knee function in bed; 6-8 After the week, you can help you to carry the weights.
2 Results There were no intraoperative deaths in this group and no infection of the incision. X-ray photos were reviewed 3-5 months after surgery, the fracture line was blurred or disappeared, and the bone texture was seen to pass through (). Except for 1 case (91 years old) died 6 months after operation, X-ray photograph fixed small trochanter fracture block at the 12th week after surgery. Fig. 2Roentgenogramtakenatthe12thweek attending physician, mainly engaged in trauma fracture and bone disease research, u medical disease, remaining 17 All cases were followed up (time 6~20 months) according to the evaluation criteria of 121 proposed by Huang Gongyi et al. The group was excellent in 14 cases and good in 3 cases, and there was no pain in walking. Except for one case, the soft tissue around the hip collapsed and the hip flexion was 20* due to the inability to adhere to the traction. The remaining 16 limbs returned to normal or near normal.
3 Discussion 3.1DHS, also known as Richards nail, is a pressurized sliding goose nail, which is mainly pressed through the sliding action of DHS in the neck of the femoral head to make close contact between the fracture ends. DHS compression screw can adjust the fracture between the fracture ends. The pressure, while the sleeve plate connects the proximal end of the fracture to the distal end, which can effectively prevent the hip from being inverted. Therefore, the nail has a static and dynamic compression effect, and has a tension band effect, which makes the internal fixation effect more ideal. 131. Wang Fuquan et al. 141 conducted a stress test on the nail, and reported that the nail has a flexural strength of 280 kg, indicating that the nail structure is stable, and the affected limb can be moved early after the fracture is fixed, thereby avoiding long-term bed rest and causing various complications, which is currently ideal. Internal fixation material. However, Fan Weimin et al. 151 reported that the anti-rotation strength of the nail is only 3.3kgm, so it is considered to be an unstable femoral intertrochanteric fracture. After DHS treatment, the rotational displacement of the fracture end due to premature ejector should be avoided.
3.2 Active treatment of complications before surgery to control cardiopulmonary function at normal or near normal levels. Patients with diabetes mellitus, control blood glucose below 8mmol / L to continue to use insulin to control blood sugar after surgery.
3.3 During the intraoperative reduction, the fracture ends of each fracture block should be restored as much as possible, so that the fracture end joints after compression are more stable and the anti-rotation force is stronger. If the small trochanter free fracture block is large, affecting the fracture reduction, the free fracture block can be fixed with the steel wire first, so that the unstable fracture becomes a stable fracture (such as the small rotor free fracture block is small, difficult to fix, Bone grafting at the face of the small rotor to restore the medial support structure and to prevent hip varus. When expanding and tapping, avoid pulling the guide pins together, otherwise the DHS cannot be fixed in the center of the femoral head. When screwing into DHS, the nail penetration depth must be mastered, generally 0.5~1.0cm from the cartilage surface of the femoral head. Elderly patients due to osteoporosis, easy to cause DHS slip and rush into the joint cavity, so the depth of the nail should be reduced by 0.5cm, that is, 1.0~2.0cm from the cartilage surface of the femoral head. When tightening the DHS compression screw, the force should not be too strong, Avoid excessive pressurization and allow DHS to slip and relax in the femoral head, resulting in unstable compression, especially in elderly patients with osteoporosis.
3.4 The affected limb should be fixed by traction to overcome the contractile force of the soft tissue around the hip, so that the affected limb can maintain the functional position. In this group, one patient refused to have limb traction due to postoperative fear. The hip joint was in a state of flexion for a long time. Despite the postoperative X-ray examination, the DHS was firmly fixed, the contralateral alignment of the fracture was good, and the bone was healed. However, the hip joint can not be stretched when standing, and the flexion of 20* seriously affects the gait of the patient. Therefore, the authors believe that all patients with DHS internal fixation surgery should be treated with lower limb traction for 3 weeks after operation to ensure that the function of the affected limb returns to normal after fracture healing.
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