Wu Meng-Huang, Lee Po-Cheng, Peng Kuo-Ti, Wu Chi-Chuan, Huang Tsung-Jen, Hsu Robert Wen-Wei
Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Chiayi, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Chang Gung Med J. 2012 Jul-Aug;35(4):345-53. doi: 10.4103/2319-4170.106135.
Polymethylmethacrylate (PMMA) cement-augmented dynamic hip screws (DHS) have been used as a solution in unstable intertrochanteric fractures (ITF). Our aim was to investigate the complications in PMMA cement-augmented DHS.
All patients who had received DHS plate osteosynthesis with or without PMMA cement augmentation from August 2005 to July 2009 in one medical center were retrospectively reviewed. The fractures were classified as unstable (31-A2.2, 31-A2.3 and 31-A3) on the basis of the Arbeitsgemeinschaft für Osteosynthesefragen classification. Inclusion criteria were patients older than 75 years, unstable ITF treated with cement-augmented DHS, and a minimum of 12 months of follow-up. Exclusion criteria were stable ITFs, incomplete chart records and imaging studies, loss to follow-up or death before bone union.
Three hundred twenty-one patients received DHS during the study period. Sixty-seven patients were included in the study (25 men and 42 women; mean age, 81.2 years). The mean follow-up time was 40.2 months, and the mean union time was 18.5 weeks (12-40 weeks). No patient had a lag screw cut-out. Six patients had delayed union or nonunion with side plate failures, including side plate breakage in 1 patient, screw breakage in 3, screw pullout in 1, and recurrent side plate breakage and screw breakage in 1. Deep infection occurred in 1 patient, and 1 had osteonecrosis at the femoral head. The procedure-related complication rate was 8.9%.
Cement-augmented DHS have a different failure mode than screw cutout in conventional DHS. Failures tended to be more related to delayed union, nonunion and resultant side plate construct failure.
聚甲基丙烯酸甲酯（PMMA）骨水泥增强动力髋螺钉（DHS）已被用作不稳定型股骨转子间骨折（ITF）的一种治疗方法。我们的目的是研究PMMA骨水泥增强DHS的并发症。
回顾性分析2005年8月至2009年7月在某医疗中心接受DHS钢板内固定术（无论是否使用PMMA骨水泥增强）的所有患者。根据 Arbeitsgemeinschaft für Osteosynthesefragen 分类法，将骨折分类为不稳定型（31-A2.2、31-A2.3和31-A3）。纳入标准为年龄大于75岁、采用骨水泥增强DHS治疗的不稳定型ITF患者，且随访时间至少12个月。排除标准为稳定型ITF、病历记录和影像学检查不完整、失访或在骨愈合前死亡。
研究期间有321例患者接受了DHS治疗。67例患者纳入研究（25例男性和42例女性；平均年龄81.2岁）。平均随访时间为40.2个月，平均愈合时间为18.5周（12 - 40周）。没有患者出现拉力螺钉穿出。6例患者出现延迟愈合或不愈合伴侧板失效，包括1例侧板断裂、3例螺钉断裂、1例螺钉拔出以及1例复发性侧板断裂和螺钉断裂。1例患者发生深部感染，1例出现股骨头坏死。与手术相关的并发症发生率为8.9%。
骨水泥增强DHS的失效模式与传统DHS的螺钉穿出不同。失效往往更多地与延迟愈合、不愈合以及由此导致的侧板结构失效有关。
