提高股骨干骨折合并同侧股骨颈骨折早期诊断率的前瞻性研究

A diagnostic protocol for ipsilateral femoral neck and shaft fractures

目的评价连续性五项检查诊断方案对股骨干骨折合并同侧股骨颈骨折早期诊断的临床效果。方法采用前瞻性研究方法，对2005年9月至2007年6月收治的股骨干骨折采用连续性的五项检查诊断方案，诊断其中合并同侧股骨颈骨折病例。包括基本3项：术前髋关节保持内旋位的前后位X线检查，术中髋部透视，术后患者麻醉清醒前摄髋关节正、侧位X线片；备选2项：股骨颈薄层CT扫描（2mm），随访期间出现髋部疼痛时摄X线片。并与2003年9月至2005年8月收治的股骨干骨折合并同侧股骨颈骨折病例常规诊断状况进行比较。结果五项方案组合并同侧股骨颈骨折的早期诊断率达93．8％，较传统方案组（46．2％）显著提高，差异有统计学意义（X2=4．069，P=0．044）。结论连续性的五项检查诊断方案能显著提高股骨干骨折合并同侧股骨颈骨折的早期诊断率。

Objective To evaluate a self-designed diagnostic protocol which can early detect a femoral neck fracture for patients with a femoral shaft fracture. Methods From September 2005 to June 2007, a self-developed protocol was used to detect an ipsilateral femoral neck fracture for all the patients with femoral shaft fracture who had sought treatment in our department. This protocol consisted of anteroposterior plain radiography of internal rotator, intraoperative fluoroscopy of the hip, a fine （2 mm） cut computed to- mographic scan through the femoral neck, postoperative anteroposterior and lateral plain radiography of the hip in the operating room prior to awakening the patient, at the time of follow-up anteroposterior and lateral plain radiography of the hip in the presence of hip pain. The diagnostic effects of the protocol were compared with those of conventional diagnosis used for all the patients with femoral shaft fracture who had sought treatment in our department from September 2003 to August 2005. A chi-square analysis comparing the protocol group （September 2005 to June 2007） and the non-protocol group （September 2003 to August 2005） was used to assess the early and delayed diagnosis rates for an associated ipsilateral femoral neck fracture. Results The early diagnosis rate of an associated femoral neck fracture by the protocol was 93.8%, markedly higher than that by conventional method （46. 2% ）, with statistically significant difference （X2 = 4. 069, P = 0. 044）. Conclusion In presence of a femoral shaft fracture, this protocol consisting of plain radiography of internal rotator, intraoperative fluoroscopy of the hip, fine cut computed tomographic scan of the femoral neck, postoperative plain radiography of the hip, and follow-up plain radiography of the hip in the presence of hip pain, may significantly improve the diagnostic rate of an associated femoral neck fracture.