股骨干骨折合并同侧股骨颈骨折的手术治疗  

Surgical treatment for ipsilateral fractures of femoral neck and shaft

作　　者：王捷[1] 张铁良[1] 于建华[1] 魏万富[1] 

机构地区：[1]天津市天津医院创伤骨科,300211

出　　处：《中华骨科杂志》2006年第5期309-312,共4页Chinese Journal of Orthopaedics

摘　　要：目的探讨股骨干骨折合并同侧股骨颈骨折的手术方法和疗效。方法回顾性分析自1996年1月至2002年12月应用手术治疗资料完整的26例股骨干骨折合并同侧股骨颈骨折患者,男22例,女4例;年龄17～50岁,平均28岁。受伤原因:交通伤17例,高处坠落伤9例。入院后即刻确诊股骨颈骨折16例;延迟诊断10例,延迟时间为3～75d,平均13.1d。全部病例均采用切开复位内固定,其中股骨干骨折采用动力加压钢板内固定13例,顺行髓内钉固定2例,逆行髓内钉固定5例,该20例患者合并的股骨颈骨折采用空心钉固定;股骨干及股骨颈骨折同时应用重建髓内钉固定4例,动力髋螺钉(DHS)固定2例。结果术后随访3～9年,平均4.4年。25例股骨干骨折于术后16～32周骨折愈合,平均20周;1例在术后18个月骨折仍未愈合,经再次手术内固定并植骨后24周愈合。25例股骨颈骨折于术后12～28周骨折愈合,平均16周;1例股骨颈骨折10个月不愈合,行全髋关节置换。术后并发症包括伤口感染1例,内固定断裂1例,股骨头缺血性坏死1例,膝关节活动受限3例。结论股骨干合并同侧股骨颈骨折相对较少,漏诊率较高(38.5%)且治疗复杂。治疗应根据股骨干骨折的部位和股骨颈骨折的移位程度来确定内固定方式。Objective To investigate the surgical treatment for ipsilateral fractures of femoral neck and shaft. Methods 26 cases of ipsilateral fractures of femoral neck and shaft treated from January 1996 to December 2002 were retrospectively reviewed. There were 22 males and 4 females, with an average of 28 years （range 17-50 years）. The causes of fractures were traffic accident in 17 and fall in 9. The femoral neck fractures were diagnosed in emergency in 16 cases, and delayedly in 10 cases. The delayed time was 3-75 days, with an average of 13.1 days. All cases were divided into three types according to the site of femeral shaft fracture. Type Ⅰ： the proximal 1/3 femoral shaft fracture combined with neck fracture, in 3 cases; Type Ⅱ： the middle 1/3 femoral shaft combined with neck fracture, in 18 cases; Type Ⅲ： the distal 1/3 femoral shaft fracture combined with neck fracture in 5 cases. All cases were undergone surgical reduction and internal fixation. The femoral shaft fractures were stabilized with dynamic compression plate （DCP） in 13, with antegrade intramedullary locking nail in 2 cases, with retrograde intramudullary locking nail in 5 cases. The femoral neck fractures of these 20 patients were stabilized with cannulated lag screw. The femoral neck and shaft were stabilized with dynamic hip screw system （DHS） in 2, with constructive nail in 4. Results All of the patients were followed up for 3 to 9 years, with an average of 4.4 years. The femoral shaft fractures obtained rigid union at the latest follow-up study in 25. The duration for bone union ranged from 16 to 32 weeks, with an average of 20 weeks. The femoral neck fractures were united at the latest follow-up study in 25. The duration for bone union ranged from 12 to 28 weeks, with an average of 16 weeks. The complications included infection in 1, hardware failure in 1, nonunion of femoral neck fracture in 1 and osteonecrosis of femoral head in 1. Conclusion The ipsilateral fracture of femoral neck and shaft is rare, and the neck fract

关 键 词：股骨骨折 股骨颈骨折 骨折固定术 内 

分 类 号：R687.3[医药卫生—骨科学]