Gadegone Wasudeo M, Chandak R M, Lokhande Vijayanand R
Government Medical College Chandrapur, Vivek Nagar Mul Road, Chandrapur, Maharashtra, India.
Chandak Orthopedic and Trauma Institute, Sitaburdi Nagpur, Maharashtra, India.
Injury. 2017 Aug;48 Suppl 2:S44-S49. doi: 10.1016/S0020-1383(17)30493-X.
The aim of this study was to assess fracture union and complications following use of dynamic hip screw (DHS) with internal bone grafting in treatment of unstable delayed presented intracapsular neck femur fractures in patients younger than 65 years of age.
Thirty two patients with displaced intracapsular neck femur fractures(Garden III and IV, Pauwels III, with comminution) with delayed presentation (15-60 days) in the 45-65 year age group (mean 54.4±10.2 years) were included in this study. All patients were treated with dynamic sliding hip screw with closed cancellous bone grafting through a tunnel of a triple reamer. The average time to union was 3.8 months (3-5 months). Satisfactory union was achieved in all patients except two. One case developed avascular necrosis of the femoral head. Other complications were coxa vara in two, shortening of less than 10mm in three cases but there were no cases of infection or implant failure. Excellent results were achieved in 27, good/fair in 4 and poor in 1 patient.
Osteosynthesis with DHS and primary cancellous bone grafting in indicated cases is a simple, providing biological stimulation for early union. Failure in a particular case can be treated with any appropriate second procedure.
本研究旨在评估在65岁以下患者中使用动力髋螺钉（DHS）结合内植骨治疗不稳定的延迟出现的囊内股骨颈骨折后的骨折愈合情况及并发症。
本研究纳入了32例年龄在45 - 65岁（平均54.4±10.2岁）、出现延迟（15 - 60天）的移位囊内股骨颈骨折（Garden III型和IV型、Pauwels III型，伴有粉碎）患者。所有患者均采用动力滑动髋螺钉结合通过三刃扩孔钻隧道进行闭合松质骨植骨治疗。平均愈合时间为3.8个月（3 - 5个月）。除2例患者外，所有患者均实现了满意的愈合。1例发生股骨头缺血性坏死。其他并发症包括2例髋内翻、3例缩短小于10mm，但无感染或植入物失败病例。27例患者结果为优，4例为良/可，1例为差。
在合适的病例中，使用DHS进行骨固定并一期植松质骨是一种简单的方法，可为早期愈合提供生物刺激。个别病例的失败可以采用任何合适的二次手术进行治疗。
