Rokito A S, Koval K J, Zuckerman J D
Department of Orthopaedic Surgery, the Hospital for Joint Diseases, New York.
Contemp Orthop. 1993 Apr;26(4):349-56.
Two hundred fifty consecutive intertrochanteric fractures treated with a sliding hip screw (SHS) over a three year period were reviewed and specific types of technical pitfalls identified. Most pitfalls were technique dependent and potentially preventable with proper attention to the principles of fracture reduction and insertion of the device. Pitfalls encountered with the use of the SHS occurred as a result of either poor fracture reduction or implant insertion. Problems related to fracture reduction included poor radiographic visualization, posterior sag, varus angulation, and internal rotation of the femoral shaft in relation to the femoral neck. Potential pitfalls encountered during SHS insertion included superior guide wire placement, guide wire breakage or penetration into the hip joint or pelvis, loss of reduction during lag screw insertion, improper screw-barrel relationship, and improper plate application. Finally, the SHS may not be the implant of choice for all extracapsular hip fractures (i.e., the reverse obliquity fracture). This paper identifies the various pitfalls that may occur with the use of the SHS for the fixation of intertrochanteric hip fractures. Illustrative cases are provided and guidelines for avoiding these surgical pitfalls suggested.
回顾了在三年期间采用动力髋螺钉（SHS）治疗的250例连续性股骨转子间骨折，并确定了特定类型的技术失误。大多数失误取决于技术，通过适当关注骨折复位和器械植入原则有可能预防。使用SHS时遇到的失误是由于骨折复位不佳或植入物植入不当所致。与骨折复位相关的问题包括X线透视不佳、后方成角、内翻成角以及股骨干相对于股骨颈的内旋。在SHS植入过程中遇到的潜在失误包括导针位置过高、导针折断或穿入髋关节或骨盆、拉力螺钉植入过程中复位丢失、螺钉与套筒关系不当以及钢板应用不当。最后，SHS可能并非所有囊外髋部骨折（即反斜形骨折）的首选植入物。本文确定了使用SHS固定股骨转子间髋部骨折时可能出现的各种失误。提供了示例病例并提出了避免这些手术失误的指南。
