Babst R, Renner N, Biedermann M, Rosso R, Heberer M, Harder F, Regazzoni P
Department of Surgery, University of Basel, Switzerland.
J Orthop Trauma. 1998 Aug;12(6):392-9. doi: 10.1097/00005131-199808000-00005.
To evaluate whether the implantation of the modular trochanter stabilizing plate (TSP) in addition to the dynamic hip screw (DHS) prevents excessive telescoping and limb shortening in four-part and selected three-part trochanteric fractures.
Prospective clinical study.
The study was conducted at the trauma unit of the Surgical Department of the University of Basel, Switzerland.
Forty-six consecutive patients with unstable intertrochanteric fractures were treated with an additional TSP super-imposed on the regular DHS at our institution between July 1991 and July 1993. Five patients died before the first follow-up, one patient was lost to follow-up, and another patient refused follow-up. Thus, thirty-nine patients were followed for at least twelve months (mean 14 months, range 12 to 20 months).
The fractures treated were classified according to the OTA classification, which is based on the AO classification. Seventeen were 31-A2.2, seven were 31-A2.3, and fourteen were 31-A3.3 fractures.
Lateralization of the greater trochanter was successfully prevented in all fractures. Limited fracture impaction was found in 90 percent (n = 35) of the patients with telescoping of 9.5 millimeters (range 0 to 30 millimeters), resulting in mean limb shortening of 5.37 millimeters (range 0 to 14.9 millimeters). Four patients suffered limb shortening exceeding fifteen millimeters (range 15.6 to 21.3 millimeters). Functional results were excellent and good in 87 percent of patients and fair in 13 percent according to the Salvati-Wilson score. All fractures had healed six months after the operation. Three complications required a secondary procedure: one from not inserting a second screw parallel to the gliding hip screw to prevent rotation of the head-neck fragment ("antirotation screw"), one because of deep infection, and one because of a refracture after premature implant removal.
In unstable pertrochanteric fractures with small or missing lateral cortical buttress, the addition of a TSP to the DHS effectively supports the unstable greater trochanter fragment and can prevent rotation of the head-neck fragment. Excessive fracture impaction and consecutive limb shortening was prevented by this additional implant in 90 percent of these patients.
评估在动力髋螺钉（DHS）基础上植入组合式转子稳定钢板（TSP）能否防止四部分及部分三部分转子骨折出现过度的套筒伸缩及肢体短缩。
前瞻性临床研究。
研究在瑞士巴塞尔大学外科创伤科进行。
1991年7月至1993年7月期间，在我们机构有46例连续的不稳定转子间骨折患者接受了常规DHS叠加额外TSP的治疗。5例患者在首次随访前死亡，1例患者失访，另1例患者拒绝随访。因此，39例患者接受了至少12个月的随访（平均14个月，范围12至20个月）。
所治疗的骨折根据基于AO分类的OTA分类进行分类。17例为31 - A2.2型，7例为31 - A2.3型，14例为31 - A3.3型骨折。
所有骨折均成功防止了大转子外移。90%（n = 35）的患者出现有限的骨折嵌插，套筒伸缩9.5毫米（范围0至30毫米），导致平均肢体短缩5.37毫米（范围0至14.9毫米）。4例患者肢体短缩超过15毫米（范围15.6至21.3毫米）。根据Salvati - Wilson评分，87%的患者功能结果为优或良，13%为中。所有骨折在术后6个月均愈合。3例并发症需要二次手术：1例是因为未平行于滑动髋螺钉插入第二枚螺钉以防止头颈骨折块旋转（“抗旋转螺钉”），1例是因为深部感染，1例是因为过早取出植入物后再骨折。
在外侧皮质支撑小或缺失的不稳定转子周围骨折中，DHS联合TSP能有效支撑不稳定的大转子骨折块，并可防止头颈骨折块旋转。在90%的此类患者中，这种额外植入物防止了过度的骨折嵌插和随之而来的肢体短缩。
