股骨干合并同侧股骨颈骨折的不同治疗方法  

Efficacy and complications of different surgical treatments for ipsilateral femoral shaft with femoral neck fractures

作　　者：冯庆虎 王友良 FENG Qinghu;WANG Youliang(Department of Orthopedics,The First People＇s Hospital,Liangshan Yi Autonomous Prefecture,Xiehang 615000,Siehuan,China)

机构地区：[1]凉山彝族自冶州第一人民医院骨外科,四川西昌615000

出　　处：《中华骨与关节外科杂志》2018年第10期763-767,共5页Chinese Journal of Bone and Joint Surgery

摘　　要：背景:股骨干合并同侧股骨颈骨折的手术方式多样,但关于最优手术方案的选择仍无统一意见。目的:比较顺向长髓内钉和逆向髓内钉联合空心钉在治疗股骨干合并同侧股骨颈骨折中的疗效和并发症。方法:本研究纳入2010年6月至2014年12月因股骨干合并同侧股骨颈骨折来我院行手术治疗的63例患者。根据内固定方式的不同,将患者分为单枚髓内钉组(30例)和联合内固定组(33例),记录并比较两组患者的一般资料:性别、年龄、股骨干AO分型、股骨颈Garden分型、合并伤、受伤至手术时间;术中情况:切口长度、手术时间、术中出血量、Garden指数;术后疗效和并发症:术后负重开始时间、骨折愈合时间、髋关节Harris评分优良率、术后膝前痛发生率、其他并发症。结果:两组患者的一般情况相近,各参数差异均无统计学意义(P>0.05)。单枚髓内钉组的切口长度、手术时间和术中出血量显著小于联合内固定组,差异有统计学意义(P<0.05)。单枚髓内钉组术后开始负重时间、术后膝前痛发生率、Harris评分优良率和骨折愈合时间均与联合内固定组相近,差异均无统计学意义(P>0.05)。至随访结束,除外术后膝前痛,其他并发症:单枚髓内钉组9例(30.0%),联合内固定组1例(3.3%);单枚髓内钉组显著高于联合内固定组(P<0.05)。单枚髓内钉组的7例(77.8%)其他并发症发生在股骨颈不稳定骨折患者中。结论:两种手术方式对于股骨干合并同侧股骨颈骨折均有效,但当有股骨颈移位时,更推荐联合内固定治疗,可减少并发症的发生。Background： There are many surgical treatments for ipsilateral femoral shaft with femoral neck fractures. However, there is no unanimous opinion on the choice of optimal surgical regimen. Objective： To compare the curative effect and complications of cisternal long nail and retrograde intramedullary nail in combination with hollow screws in the treatment of ipsilateral femoral shaft and femoral neck fractures. Methods： From June 2010 to December 2014, 63 patients undergoing surgical treatment in our hospital due to ipsilateral femoral shaft with femoral neck fractures were included in this study. Single intramedullary nailing was used in 30 patients and combined internal fixation was applied in the other 33 patients. General information, intraoperative and postoperative efficacy and complications, including gender, age, AO type of femoral shaft, Garden classification of femoral neck, combined injury, time from injury to operation, incision length, operation time, intraoperative blood loss, Garden index, postoperative weight-bearing start time, fracture healing time, hip Harris score, postoperative incidence of knee pain, other complications were compared between two groups. Results： There was no significant difference in the baseline information between two groups（P〈0.05）. Single intramedullary nail group had shorter incision length, less operation time and intraoperative blood loss than combined internal fixation group（P〈0.05）. No significant difference was found in the weight-bearing start time, the incidence of pre-anterior knee pain, Harris score or fracture healing time between two groups（P〈0.05）. At the end of follow-up, with the exception of knee pain, other complications occurred in 9 patients（30.0%） in the single intramedullary nail group and 1 patient（3.3%） in the combined internal fixation group, and the incidence of other complications in the single intramedullary nail group was significantly higher than that in the combined internal fixation group（P〈0.05）. More

关 键 词：股骨骨折 股骨颈骨折 骨折固定术 疗效 并发症 

分 类 号：R687.3[医药卫生—骨科学]