Barwar Nilesh, Meena Sanjay, Aggarwal Shashi Kant, Garhwal Prashant
Department of Orthopedics, All India Institute of Medical Sciences, New Delhi 110029, India.
Chin J Traumatol. 2014 Apr 1;17(2):88-92.
Dynamic hip screw (DHS) is recommended for the fixation of stable intertrochanteric fractures. Its postoperative cut-out rate ranges from 1% to 6%. In osteoporotic bone, normal screws in DHS blade provide less anchorage compared to locking screws. This study aims to compare DHS with locking side plate and conventional side plate.
Fifty consecutive patients with intertrochanteric fractures were randomly allocated for fixation with a standard DHS (group A) and locking DHS (Combi plate, group B). We compared the clinical and radiological outcomes for the conventional DHS and locking DHS in intertrochanteric fractures. Functional outcome was evaluated using the Parker mobility score.
Coxa valga was found more frequently in group A than in group B (12% vs. 0%, P=0.42). Coxa vara showed the same trend (12% vs. 8%, P=0.81). Rate of restoration of postoperative neck-shaft angle within 20° of sound side was higher in group B (8% cases) than in group A (4% cases, P=0.98). The rate of anteversion angle restoration within 10° of sound side was also higher in group B (100% vs. 88%, P=0.85). The average lag screw slippage in group A and group B was 3.2 mm and 4.2 mm, the average fracture union duration was 17.1 weeks and 16.4 weeks, and the mean Parker score was 5.6 and 5.8 respectively. Screw cut-out was seen in one patient in group A. No cut-out was seen in any of the patient in group B. No patient developed deep infection, avascular necrosis, deep vein thrombosis or any other significant complications.
The present study demonstrated that treating intertrochanteric fracture with a locking DHS allows sound bone healing and is not associated with any major complications. Although this report is promising, it should be interpreted with caution because only a prospective study with a large sample size would allow definitive conclusion.
动力髋螺钉（DHS）推荐用于稳定型股骨转子间骨折的固定。其术后穿出率为1%至6%。在骨质疏松性骨中，DHS刀片中的普通螺钉与锁定螺钉相比提供的锚固力较小。本研究旨在比较DHS与锁定侧板和传统侧板。
连续50例股骨转子间骨折患者被随机分配接受标准DHS固定（A组）和锁定DHS（组合钢板，B组）。我们比较了传统DHS和锁定DHS治疗股骨转子间骨折的临床和影像学结果。使用帕克活动评分评估功能结果。
A组发现髋外翻的频率高于B组（12%对0%，P = 0.42）。髋内翻呈现相同趋势（12%对8%，P = 0.81）。术后颈干角恢复到健侧20°以内的比例B组（8%病例）高于A组（4%病例，P = 0.98）。前倾角恢复到健侧10°以内的比例B组也更高（100%对88%，P = 0.85）。A组和B组拉力螺钉的平均滑移分别为3.2毫米和4.2毫米，平均骨折愈合时间分别为17.1周和16.4周，平均帕克评分分别为5.6和5.8。A组有1例患者出现螺钉穿出。B组患者均未出现穿出。没有患者发生深部感染、缺血性坏死、深静脉血栓形成或任何其他重大并发症。
本研究表明，用锁定DHS治疗股骨转子间骨折可实现良好的骨愈合，且不伴有任何重大并发症。尽管本报告很有前景，但应谨慎解读，因为只有大样本的前瞻性研究才能得出明确结论。
