不同内固定在股骨干合并同侧股骨颈骨折的疗效分析  

Efficacy of different internal fixation in treatment of femoral neck fracture with ipsilateral femoral shaft fracture

作　　者：石振[1] 成昊[1] 焦志坚 许益文[1] 张柘[1] 郑勇[1] 

机构地区：[1]湖北省咸宁市中心医院湖北科技学院附属第一医院创伤骨科,437100

出　　处：《临床外科杂志》2017年第8期598-601,共4页Journal of Clinical Surgery

摘　　要：目的比较股骨重建髓内钉与倒打钉+空芯加压螺钉在治疗股骨干合并同侧股骨颈骨折的治疗作用,并评价效疗。方法股骨干合并同侧股骨颈骨折的病人31例。根据所接受的内固定方式不同将病人分成A、B两组,其中A组13例,采用股骨重建髓内钉同时固定股骨干和股骨颈骨折;B组18例,采用倒打钉固定股骨干骨折、空芯加压螺钉固定股骨颈骨折,比较两组手术时间、出血量、骨愈合时间、并发症及术后患肢功能恢复情况。依据髋关节功能Harris评分标准,对病人术后患肢髋功能进行效果评价。结果两组病人随访时间为6~4个月,平均随访14.3个月;A组手术时间(180.0±16.0)分钟,术中失血量(220.0±30.5)ml,术后出现内固定物移位2例,股骨头坏死1例。B组手术时间(110.0±18.5)分钟,术中失血量(120.0±20.5)ml,术后内固定物移位1例;两组病人手术时间、出血量、并发症、术后髋关节功能评分比较差异有统计学意义(P<0.05)。两组股骨骨折的愈合时间分别为(12.0±3.5)天和(11.0±2.5)天,股骨颈骨折的愈合时间分别为(9.0±3.3)天和(10.0±4.2)天,差异无统计学意义(P>0.05)。结论倒打钉+空芯钉治疗股骨干合并同侧股骨颈骨折手术时间、出血量、术后并发症及术后髋关节功能等方面更具优势。股骨重建髓内钉治疗,学习曲线长,医务人员受到的辐射较多,手术耗时更长。Objective To compare the therapeutic effect of femoral reconstruction intramedullary nail and cannulated screw in treatment of femoral shaft fracture with ipsilateral femoral neck fracture.Methods A retrospective analysis of followed up 31 cases of femoral shaft fracture combined with ipsilateral femoral neck fracture. According to different patients received internal fixation were divided into A,B groups. 13 patients in group A（ 7 male and 6 female） treated with femoral reconstruction intramedullary nail fixed femoral shaft and neck fractures; group B of 18 patients（ 10 male and 8 female） treated with retrograde nailing of femoral shaft fracture,fracture of hollow compression screw fixation of femoral neck.Compared two groups of operation time,bleeding volume,bone healing time,complications and postoperative limb function recovery and other aspects of the differences. On the basis of Harris hip joint function evaluation of standard for evaluation,postoperative limb hip function. Results The two patients were followed up for 6-24 months,the average follow-up time was 14. 3 months; the operation time of group A was（ 180. 0 ± 16. 0） minutes,intraoperative blood loss was（ 220. 0 ± 30. 5） ml. 2 cases of internal fixation after operation,1 cases of femoral head necrosis. The operation time of group B was（ 110. 0 ± 18. 5） minutes,intraoperative blood loss was（ 120. 0 ± 20. 5） ml. 1 case of postoperative internal fixation. There were significant difference between the two group in operation time,bleeding volume,postoperative complications and hip function score（ P 0. 05）. The healing time of group A and group B were（ 12. 0 ± 3. 5） days and（ 11. 0 ± 2. 5） days,respectively. The healing time of femoral neck fracture were（ 9. 0 ± 3. 3） days and（ 10. 0 ±4. 2） days,respectively. Conclusion Compared with reconstruction intramedullary nail in treatment of fracture in the operation time,bleeding volume,complications and postoperative hip function after operation,inverted nail

关 键 词：股骨骨折 股骨颈骨折 骨折固定术 重建钉 

分 类 号：R687.3[医药卫生—骨科学]