Department of Orthopaedic Surgery, Good Samsun Hospital, Busan, Korea.
Clin Orthop Surg. 2011 Jun;3(2):107-13. doi: 10.4055/cios.2011.3.2.107. Epub 2011 May 12.
To evaluate the utility of additional fixation methods and to suggest a method of reduction in the treatment of unstable pertrochanteric femur fractures with a sliding hip screw (SHS).
A retrospective study was performed on thirty patients with unstable pertrochanteric femur fractures, who were operated on with a SHS between September 2004 and September 2009 and were followed up for at least 6 months. The additional fixation devices were as follows; antirotation screw (21 cases), fixation of displaced fractures of the posteromedial bone fragment (cerclage wiring, 21 cases and screw, 2 cases) and trochanter stabilizing plate (27 cases). Clinically, the Palmer's mobility score and Jensen's social function group were used. Radiologically, alignment and displacement were observed. The tip-apex distance (TAD) and sliding of the lag screw were measured, and the position of the lag screw within the femoral head was also examined.
The mean age at the time of surgery was 76 years (range, 56 to 89 years) and the average follow-up period was 25 months (range, 6 to 48 months). At the last follow-up, the average mobility and social function score was 6.2 (± 3.5) and 2.3 (± 1.5). Postoperatively, the alignment and displacement indices were adequate in almost all the cases. The mean amount of lag screw sliding and the mean TAD was 5.1 mm (range, 2 to 16 mm) and 6 mm (range, 3 to 11 mm) respectively. The lag screws were located in the center-center zone in 21 cases. The average period to union was 18.7 weeks without any cases of nonunion or malunion. Mechanical failure was noted in one case with breakage of the lag screw and clinical failure was noted in another case with persistent hip pain related to excessive sliding (16 mm).
With additional fixations, the unstable pertrochanteric femur fractures could be well stabilized by SHS until bone union.
评估附加固定方法的效用，并提出一种治疗不稳定型股骨转子间骨折的方法，该方法使用滑动髋螺钉（SHS）进行复位。
对 2004 年 9 月至 2009 年 9 月期间使用 SHS 治疗的 30 例不稳定型股骨转子间骨折患者进行回顾性研究，并进行了至少 6 个月的随访。附加固定装置如下：防旋螺钉（21 例）、固定后内侧骨块移位骨折（环形扎带，21 例和螺钉，2 例）和转子稳定钢板（27 例）。临床使用 Palmer 活动评分和 Jensen 社会功能组进行评估。影像学上观察对线和移位情况。测量尖端-顶点距离（TAD）和拉力螺钉的滑动，并检查拉力螺钉在股骨头内的位置。
手术时的平均年龄为 76 岁（56 岁至 89 岁），平均随访时间为 25 个月（6 个月至 48 个月）。末次随访时，平均活动度和社会功能评分为 6.2（±3.5）和 2.3（±1.5）。术后，几乎所有病例的对线和移位指数均良好。平均拉力螺钉滑动量和平均 TAD 分别为 5.1mm（2mm 至 16mm）和 6mm（3mm 至 11mm）。21 例拉力螺钉位于中心-中心区。平均愈合时间为 18.7 周，无不愈合或畸形愈合病例。1 例出现拉力螺钉断裂的机械性失败，1 例出现与过度滑动相关的持续性髋部疼痛的临床失败（16mm）。
通过附加固定，不稳定型股骨转子间骨折可通过 SHS 得到良好的稳定，直至骨愈合。
