Hsu Yu-Tun, Wu Chi-Chuan, Su Chun-Yi, Fan Kuo-Fun, Tseng I-Chuan, Cheou Yi-Lee
Department of Orthopedics Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan.
Chang Gung Med J. 2006 Mar-Apr;29(2):190-7.
Subtrochanteric fractures possess unique characteristics, and no single device used in their treatment is considered absolutely superior to others. Use of sliding compression screws (SCSs) is technically simple. The feasibility of SCS stabilization was evaluated using indirect reduction of fracture fragments.
One hundred and thirty-one acute subtrochanteric fractures without extensive shaft involvement were treated using this technique, and they were classified into 4 groups to evaluate the success rate. After the lag screw was inserted into the femoral head, the side plate was applied onto the distal fragment without exploring the fracture site. At least 4 cortical screws were used to stabilize the distal fragment. Postoperatively, ambulation with protected weight bearing was encouraged at as early a time as was possible.
One hundred and thirteen fractures were followed-up for 12 to approximately 38 (mean, 22) months. The union rate was 94.7% (107/113), and the time period until union occurred was 2.5 to approximately 8 (mean, 3.8) months. No statistical difference was noted among the individual groups. Complications included 6 nonunions (5.3%), which were associated with infection in 1 case (0.9%) and implant failure in 2 cases (1.8%).
Compared to other techniques, indirect reduction with SCS stabilization is a feasible method for treating acute subtrochanteric fractures. However, because plate insertion normally requires a large dissecting wound and biomechanically the tension band principle might not be applicable, there may be greatly increased complications with extensively comminuted fractures. Accordingly, if this technique is used for carefully selected fractures, a high success rate can be expected.
转子下骨折具有独特的特点，在其治疗中使用的任何单一器械都不被认为绝对优于其他器械。滑动加压螺钉（SCS）的使用在技术上较为简单。通过间接复位骨折碎片来评估SCS固定的可行性。
采用该技术治疗了131例无广泛骨干累及的急性转子下骨折，并将其分为4组以评估成功率。在将拉力螺钉插入股骨头后，将侧板应用于远侧骨折块，而不探查骨折部位。至少使用4枚皮质骨螺钉固定远侧骨折块。术后尽早鼓励患者在保护下负重行走。
113例骨折获得随访，随访时间为12至约38（平均22）个月。骨折愈合率为94.7%（107/113），骨折愈合时间为2.5至约8（平均3.8）个月。各分组之间未发现统计学差异。并发症包括6例骨不连（5.3%），其中1例（0.9%）与感染有关，2例（1.8%）与内植物失败有关。
与其他技术相比，SCS固定间接复位是治疗急性转子下骨折的一种可行方法。然而，由于钢板置入通常需要较大的手术切口，且在生物力学上张力带原则可能不适用，因此对于广泛粉碎性骨折，并发症可能会大大增加。因此，如果将该技术用于精心选择的骨折病例，有望获得较高的成功率。
