O'Malley Natasha T, Deeb Andrew-Paul, Bingham Karilee W, Kates Stephen L
Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY, USA.
Geriatr Orthop Surg Rehabil. 2012 Jun;3(2):68-73. doi: 10.1177/2151458512450707.
The dynamic helical hip system (DHHS; Synthes, Paoli, Pennsylvania) differs from the standard dynamic sliding hip screw (SHS) in that in preparing for its insertion, reaming of the femoral head is not performed, thereby preserving bone stock. It also requires less torque for insertion of the helical screw. The associated plate has locking options to allow locking screw fixation in the femoral shaft, thereby decreasing the chance of the plate pulling off. While biomechanical studies have shown improved resistance to cutout and increased rotational stability of the femoral head fragment when compared with traditional hip lag screws, there is limited information on clinical outcome of the implant available in the literature.
We report a single surgeon series of 87 patients who were treated for their per-trochanteric hip fractures with this implant to evaluate their clinical outcome and compare it with a cohort of 344 patients who were treated with the standard SHS. All data were prospectively collected, most as part of a structured Geriatric Fracture Care Program.
The 2 groups were similar demographically, and medically, with similar rates of in-hospital complications and implant failure. Failure in the DHHS group was attributable to use of the implant outside its indications and repeated fall of the patient.
This limited case series showed that the DHHS outcomes are comparable with that of the SHS. Whether there is any benefit to its use will require larger, prospective randomized controlled trials.
动态螺旋髋系统（DHHS；辛迪斯公司，宾夕法尼亚州波利）与标准动力髋螺钉（SHS）不同，在准备植入时，无需对股骨头进行扩髓，从而保留了骨量。其螺旋螺钉植入时所需扭矩也较小。相关钢板有锁定选项，可在股骨干中使用锁定螺钉固定，从而降低钢板松动的几率。虽然生物力学研究表明，与传统髋部拉力螺钉相比，该系统对股骨头碎片的抗切割能力增强，旋转稳定性提高，但文献中关于该植入物临床结果的信息有限。
我们报告了由同一位外科医生治疗的87例使用该植入物治疗转子周围髋部骨折患者的系列病例，以评估其临床结果，并与344例接受标准SHS治疗的患者队列进行比较。所有数据均为前瞻性收集，大部分作为结构化老年骨折护理计划的一部分。
两组在人口统计学和医学方面相似，住院并发症和植入物失败率相近。DHHS组的失败归因于超出其适应证使用该植入物以及患者反复跌倒。
这个有限的病例系列表明，DHHS的结果与SHS相当。其使用是否有任何益处需要更大规模的前瞻性随机对照试验来验证。
