Dynamic hip screw for the treatment of femoral trochanteric fractures Huang Huabin, Department of Orthopaedics, Second Affiliated Hospital of Jiangxi Medical College, Nanchang, 30006) The femoral trochanteric fracture is a well-recognized complex fracture, and the majority of elderly patients are treated with reduced mortality and reduced hip turn. Since 1998 to 2001, we have treated a group of these patients with the AO Dynamic Hip Screw (DHS) method, which is reported below.
1 Clinical data 1.1 General information: This group of patients a total of 65 patients, 49 males and 16 females; the youngest 35 years old, the largest 81 years old average 58 years old. There were 39 cases of fractures on the left side and 26 cases on the right side. The causes of injury were 35 cases of flat fall, 23 cases of high ground fall, 7 cases of traffic accidents, and AO classification of fractures: 25 cases of A1 group and 37 cases of A2 group. 3 cases in group A3. Injury to surgery for the shortest 3d, the longest 123 average 7d. 1.2 Methods and results: do the lateral incision of the fracture, after the fracture is reset, and temporarily fixed with a reset forceps or Kirschner wire, with DHS angle guide 135 degrees) In the lateral femoral cortex, and the catheter is directed to the center of the femoral head, drill the threaded 2mm guide needle to the femoral head cartilage 10mm, measure the length of the guide needle in the bone, according to the length minus 10mm is required DHS screw length; adjust the DHS triple reamer depth according to the length of the DHS screw, insert the guide needle to the center of the femoral head to ream the hole to a defined depth, screw the DHS screw, connect the DHS plate to the screw, and use the special driver The plate was driven until the plate was pressed against the lateral femur of the femur, and a screw-fixed plate was drilled into the cortical bone. Finally, pressurize the screw at the end of the DHS screw. In the case that the patient can tolerate, the patient can sit up the next day after surgery, gradually increase the activity of the knee joint and the ankle. After the suture removal, the patient can be abducted to the ground. After 4 weeks, the weight of the crutches is walking to the fracture healing.
This group of 65 patients, followed up for 5 to 18 months, an average of 8 months, all patients achieved bone healing, no infection and serious cardiovascular and cerebrovascular complications; efficacy according to Huang Gongyi standard assessment 71: excellent: 27 cases, good : 5 cases, can be: example, poor: 0. 2 discussion 2.1 surgical indications: intertrochanteric fractures occur mostly in the elderly, treatment is divided into non-surgical treatment and surgical treatment, the former takes 2 to 3 months The continuous bed traction time, the lungs, urinary tract infections and hemorrhoids caused by prolonged bed rests seriously threaten the life of the patient. Fixing the pain to the fracture end is an important cause of the onset or aggravation of cardiovascular and cerebrovascular diseases in the elderly. It has been reported that 728 non-surgical treatment has a 4 to 5 times higher mortality rate than surgery, followed by non-surgical treatment of hip varus with a rate of 40% to 50%. 73. A significant range of biomechanics and structures can occur in patients with hip varus. Changes that cause obvious clinical symptoms. For the above reasons, we believe that patients with intertrochanteric fractures should consider active surgical treatment, so that patients with early activities to reduce complications, restore limb function, improve quality of life, only a few general conditions are too poor, difficult to tolerate anesthesia and surgical strikes Exception.
2.2 Mechanical principle of internal fixation equipment: The basic components of dynamic hip screw include a round head, large and wide threaded screws, a sleeve plate and compression screws, which provide a reliable internal fixation for intertrochanteric fractures, adapting to most rough The main advantage of intertrochanteric fractures and subtrochanteric fractures is that the screws are strongly fixed in the femoral head and can be effectively fixed even in the case of osteoporosis; the sliding mechanism in the sleeve can prevent the screw from penetrating the femoral head or hip.臼; the weight-bearing pressure is transmitted directly to the bone rather than the internal fixation; the muscle around the hip contracts and the load-bearing activity produces dynamic compression through the sliding device of the dynamic hip screw, and can continue to be maintained after surgery, thus maintaining the fracture The reduction and tightening promote fracture healing.
2.3 Operation points: The operation should be carried out with the aid of X-ray imaging equipment, and there should be a complete set of tools, strictly in accordance with the operation steps, the more critical steps are accurate reset and correct entry of the guide needle, there should be before surgery An X-ray plain film of the extreme internal rotation of the contralateral hip should be accompanied by a fixed length metal marker to calculate the X-ray magnification. The purpose of this is to understand the full length of the femoral neck so that the corresponding length of the screw is prepared. Secondly, an ideal needle insertion point is selected for the 135 degree DHS plan. According to our experience, the general needle insertion point is mostly at the level of the upper edge of the small trochanter. In addition to the selection of the needle point, the needle must be considered to be consistent with the forward tilt angle when the needle is inserted. Otherwise, the needle can be pushed forward or backward. We routinely tighten before the needle is inserted. Insert a Kirschner wire in front of the femoral neck as a marker of the anteversion angle of the femoral neck and make the inserted guide pin parallel. Once the position of the guide pin is determined, the next operation is fixed and programmed. The ideal position of the guide pin should be at the center position on the positive side, so as to ensure that the cannulated bone screw under the joint is 10mm under the joint. The femoral head is not worn in position, and the cancellous bone screw is located in the center and deep position to ensure that it is securely attached to the best available bone and does not clamp the sleeve when it is maximally sliding and pressurized. Two factors can reduce the risk of failure of internal fixation machinery. Therefore, special attention should be paid to the position of the guide pin in the front and rear position and the lateral position. If it appears too close to the side or shallow, it should be corrected in time.
2.4 postoperative functional exercise is a necessary means to improve the efficacy: DHS internal fixation for the treatment of intertrochanteric fractures in order to make patients early activities, in addition to help reduce complications, lower limb muscle exercises and joints on a strong internal fixation Activity is an important part of maximizing recovery function. Therefore, we encourage patients to sit up and start activities on the next day after surgery. After 3~4 days, they can help patients to perform passive activities such as hip and knee joints. Under the condition of no pain and no weight. Functional exercise can achieve satisfactory lower limb joint mobility. Then according to the stability of the fracture and the degree of osteoporosis and the results of the review of the 5-line, the individual weight-bearing time is determined individually. Generally, the patient can reach the full weight in 8 to 12 weeks. Through the follow-up results of this group of patients, our experience is an effective method for the treatment of femoral intertrochanteric fractures with DHS. Because the internal fixation is strong and reliable, the elderly patients can be active early, which can significantly reduce serious complications and mortality. Limit the recovery of limb function and significantly improve the quality of life of patients.
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