Lakho Muhammad T, Jatoi Asif A, Azfar Muhammad Khanzada, Ali Aijaz, Javed Safiya, Bhatti Anisuddin, Karim Musa
Orthopedics, Jinnah Postgraduate Medical Center, Karachi, PAK.
Orthopedics, Jinnah Postgraduate Medical Center, Karachi , PAK.
Cureus. 2019 Apr 1;11(4):e4360. doi: 10.7759/cureus.4360.
Introduction Intertrochanteric fractures are the most frequently operated fracture type and have the highest postoperative fatality rate. The most commonly used devices are the dynamic hip screw (DHS) with side plate assemblies and proximal femoral nail (PFN). The aim of this study was to determine the functional and radiological outcome of unstable intertrochanteric fracture post DHS fixation at a tertiary care hospital in Karachi, Pakistan. Methods A study was carried out in the department of orthopedics at the Jinnah Postgraduate Medical Center (JPMC), from 12th June 2016 to 8th September 2017. A total of 106 patients between 18 and 75 years of age with unstable intertrochanteric fracture were included. Those patients who had multiple injuries and open fractures, subtrochanteric fractures, intracapsular fractures neck of femur, pathological fractures and patients who were non-ambulatory prior to their injury were excluded. Functional outcomes were measured both during pain using the visual analog scale and range of motion on goniometer between 80 and 100 degrees. Satisfactory outcomes were measured after three months. Results A total of 106 patients with the radiological diagnosis of the unstable intertrochanteric fracture having post DHS fixation were included in this study. Out of which, 69.8% (74) were males and the mean age was 66.61 ± 7.79 years over the range of 50 to 80 years. Patients with type II diabetes were 22.6% (24) with a mean duration of 4.3 ± 8.37 years. At the end of three months, no pain was reported in 82.1% (87) patients and 85.8% (91) patients had normal function. The satisfactory radiological outcome was observed in 86.8% (92) patients. Overall, acceptable outcomes were observed in 81.1% (86) patients at the end of three months. Conclusion The treatment of unstable intertrochanteric fracture with dynamic hip screw (DHS) fixation results in better outcomes. In our study, we observed acceptable outcomes in a vast majority, 81.1%, of patients after three months of DHS fixation of the unstable intertrochanteric fracture.
引言
股骨转子间骨折是最常进行手术的骨折类型，且术后死亡率最高。最常用的器械是带侧板组件的动力髋螺钉（DHS）和股骨近端髓内钉（PFN）。本研究的目的是确定在巴基斯坦卡拉奇一家三级护理医院，不稳定股骨转子间骨折采用DHS固定后的功能和影像学结果。
方法
2016年6月12日至2017年9月8日期间，在真纳研究生医学中心（JPMC）骨科进行了一项研究。纳入了106例年龄在18至75岁之间的不稳定股骨转子间骨折患者。排除那些有多处损伤、开放性骨折、转子下骨折、股骨颈囊内骨折、病理性骨折以及受伤前不能行走的患者。在疼痛期间使用视觉模拟量表测量功能结果，并使用测角器测量80至100度之间的活动范围。三个月后测量满意结果。
结果
本研究纳入了106例经放射学诊断为不稳定股骨转子间骨折且已行DHS固定的患者。其中，69.8%（74例）为男性，平均年龄为66.61±7.79岁，年龄范围在50至80岁之间。患有II型糖尿病的患者占22.6%（24例），平均病程为4.3±8.37年。在三个月结束时，82.1%（87例）的患者报告无疼痛，85.8%（91例）的患者功能正常。86.8%（92例）的患者影像学结果满意。总体而言，在三个月结束时，81.1%（86例）的患者观察到可接受的结果。
结论
采用动力髋螺钉（DHS）固定治疗不稳定股骨转子间骨折可取得更好的结果。在我们的研究中，我们观察到在不稳定股骨转子间骨折行DHS固定三个月后，绝大多数（81.1%）患者的结果是可接受的。
