股骨干骨折合并同侧股骨颈骨折的手术治疗  

Surgical treatment for ipsilateral femoral neck and shaft fracture

作　　者：窦帮 麻文谦 秦涛 朱玮[1] 戴亚辉 徐小彬 DOU Bang;MA Wen-qian;QIN Tao;ZHU Wei;DAI Ya-hui;XU Xiao-bin(Department of Orthopaedics,Songjiang Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai201600,China)

机构地区：[1]上海交通大学医学院附属松江医院<筹>骨科,上海201600

出　　处：《中国骨伤》2023年第3期203-208,共6页China Journal of Orthopaedics and Traumatology

基　　金：上海市松江区科技攻关项目(编号:16SJGG24)。

摘　　要：目的:探讨单结构和双结构治疗股骨干骨折合并同侧股骨颈骨折的疗效及其适应证。方法:2015年6月至2020年12月收治同侧股骨干合并股骨颈骨折患者21例,男14例,女7例,年龄23~69(38.1±12.9)岁。根据不同股骨干骨折部位分别采用InterTan或PFNAⅡ固定(单结构),以及逆行髓内钉+空心钉固定(双结构)。术后定期随访功能及并发症情况。单结构固定10例,股骨颈骨折均为基底型,股骨干骨折位于峡部近端;双结构固定11例,9例为股骨颈基底型,2例经颈型,股骨干骨折位于峡部及其远端。结果:所有患者获得随访,时间12~27个月。所有单结构固定患者未发生股骨头坏死、畸形、延迟和不愈合,股骨干骨折未发生延迟愈合、不愈合;末次随访Harris评分(91.8±4.1)分,优8例,良2例。所有双结构固定患者股骨颈骨折获得了良好的愈合,未发生股骨头坏死,1例股骨干骨折延迟愈合;末次随访Harris评分(92.4±5.9)分,优7例,良3例,一般1例。结论:良好的复位和固定是治疗这类骨折的关键。单结构和双结构固定均是良好选择,应根据股骨干和股骨颈骨折部位选择适合的固定方式。对于股骨干骨折位于峡部近端而股骨颈骨折为基底型,可选择单结构固定,对于峡部及以下股骨干骨折合并同侧股骨颈骨折建议双结构固定。Objective To retrospectively analyze efficacy of single structure internal fixation and double structure internal fixation in the treatment of ipsilateral femoral shaft and neck fracture,and analyze their indications.Methods From June 2015 to December 2020,21 patients with ipsilateral femoral shaft and femoral neck fracture were treated,including 14 males and 7 females,aged 23 to 69 years old with an average of(38.1±12.9)years old.According to different femoral shaft fracture sites,some patients were fixed with cephalomedullary implant for both femoral neck and the femoral shaft(single structure,InterTan or PFNAⅡ),some patients were fixed with cannulated screws for the femoral neck and a retrograde locking nail for the femoral shaft(dual structure),and postoperative function and complications were recorded during follow-up.In 10 cases of single-structure fixation,the femoral necks were all basicervical fractures,and the femoral shaft fractures were located in the proximal isthmus;11 cases were double-structure fixation,9 cases in 11 were basal type of femoral neck,2 cases in 11 were neck type,and the femoral shaft fractures were located in the isthmus and the distal isthmus.Results All patients were followed up for 12 to 27 months.No femoral head necrosis,deformity,delay or nonunion occurred in the patients with single-structure fixation,and no delayed union or nonunion occurred in femoral shaft fractures;At the final follow-up,Harris score of patients with single-structure fixation was 91.8±4.1,with 8 cases were excellent and 2 cases were good.The fractures of patients with dual-structure fixation achieved good union without femoral head necrosis,except 1 case of femoral shaft fracture had delayed union;At the final follow-up,Harris score of patients with dual-structure fixation was 92.4±5.9,7 cases were excellent,3 cases were good,and 1 case was fair.Conclusion Good reduction and fixation is the key to the treatment of such fractures.Both the single-structure fixation and the dual-structure fixation are go

关 键 词：股骨干骨折 股骨颈骨折 同侧 骨折固定术 解剖复位 

分 类 号：R683.42[医药卫生—骨科学]