Said G Z, Farouk O, El-Sayed A, Said H G
Department of Orthopaedic Surgery and Traumatology, Assiut University Hospitals, 71516 Assiut, Egypt.
Injury. 2006 Feb;37(2):194-202. doi: 10.1016/j.injury.2005.09.011. Epub 2005 Dec 27.
Twenty-six patients with failed dynamic hip screw fixation of intertrochanteric fractures were included in this study. The mean age of the patients was 61 years (range, 38-84 years). Average limb shortening was 2.4 cm; 18 patients were treated with revision internal fixation and eight patients with prosthetic replacement. The decision depended on the physiological age of the patient, quality of bone, and condition of the femoral head and the acetabulum. The revision internal fixation group included DHS reinsertion in eight patients, valgus osteotomy and revision DHS fixation in six, while four patients were treated by valgus osteotomy and insertion of single-angled 130 degrees plate. The prosthetic replacement group included cemented Thompson endoprothesis in five patients and cemented total hip arthroplasty in three. The mean follow-up period was 31 months (range, 15-72 months). All patients of revision internal fixation group achieved fracture healing without bone grafting. Time to union averaged 17 weeks. Average gain in length was 2 cm Avascular necrosis of the femoral head occurred in one patient. Six patients of the prosthetic replacement group achieved good functional outcome and pain-free gait. The remaining two had unsatisfactory result.
本研究纳入了26例动力髋螺钉固定股骨转子间骨折失败的患者。患者的平均年龄为61岁（范围38 - 84岁）。平均肢体短缩2.4厘米；18例患者接受了翻修内固定治疗，8例患者接受了假体置换。治疗方案的选择取决于患者的生理年龄、骨质、股骨头及髋臼情况。翻修内固定组中，8例患者重新植入动力髋螺钉，6例进行外翻截骨及翻修动力髋螺钉固定，4例接受外翻截骨并植入130度单角钢板。假体置换组中，5例患者采用骨水泥型汤普森假体，3例采用骨水泥型全髋关节置换术。平均随访时间为31个月（范围15 - 72个月）。翻修内固定组所有患者均未植骨而实现骨折愈合。骨折愈合时间平均为17周。平均肢体长度增加2厘米。1例患者发生股骨头缺血性坏死。假体置换组6例患者功能恢复良好，步态无痛。其余2例效果不满意。
