股骨干合并同侧股骨颈或股骨转子间骨折

Ipsilateral femoral neck or intertrochanteric and shaft fractures

目的 探讨股骨干合并同侧股骨颈或股骨转子间骨折的临床特点和漏诊原因。方法 8例股骨干骨折分别采用普通髓内钉、钢板、带锁髓内钉固定。其中合并股骨颈、股骨转子间骨折的 6例选用DHS、带锁髓内钉、空心螺钉固定 ;术前漏诊 2例采用非手术治疗。结果 8例全部获随访 ,随访时间 5个月～ 2年。股骨干及股骨颈、股骨转子间骨折均获骨性愈合 ,伤肢功能恢复满意。结论 对高能量损伤造成股骨干骨折应常规摄骨盆前后位X线片及膝部X线片。一旦发现合并股骨颈或股骨转子间骨折 ,应争取早期手术内固定 。

Objective To investigate the clinical characteristics and causes of missed diagnosis of ipsilateral femoral neck or intertrochanteric and shaft fractures. Methods 8 cases of femoral shaft fractures were treated with general intramedullary nail, plate and locking intramedullary nail. 6 patients associated with femoral neck or intertrochanteric fractures were treated with DHS, locking intramedullary nail and cannulated screws. 2 missed diagnosed preoperatively patients were treated conservatively after operation. Results 8 cases were followed up for 5 months to 2 years. All femoral shaft and femoral neck or intertrochanteric fracture were found to get bony union. The extremity founction recovered satisfactorily. Conclusion In case of femoral shaft fracture resulting from high-energy injury, an AP pelvic film and knee film should be routinely taken. Once the femoral neck or intertrochanteric fractures is recognized, operative reduction and fixation should be employed in time. The outcome of operative treatmant is satisfactory.