同侧股骨干合并股骨颈骨折的手术治疗

Surgical Treatment for Ipsilateral Fractures of the Hip and Femoral Shaft

目的探讨同侧股骨干合并股骨颈骨折的手术方法和疗效。方法回顾性分析2001年5月-2008年9月应用手术治疗的14例同侧股骨干合并股骨颈骨折患者,男性9例,女性5例。受伤原因:交通伤13例,高处坠落伤1例。14例中股骨干上1/3骨折2例,股骨干中1/3骨折9例,股骨干下1/3骨折3例。股骨颈骨折均为基底型,按照Garden分型:Ⅱ型8例,Ⅲ型5例,Ⅳ型1例,开放性骨折3例。全部病例均行内固定,其中采用股骨重建钉内固定4例,股骨髁上髓内钉+中空加压螺钉内固定8例,动力髋螺钉(DHS)内固定2例。结果术后随访10个月～5年,平均18个月。股骨颈骨折漏诊3例(漏诊率21.4%)。股骨干骨折愈合时间为14～22周,平均18周。股骨颈骨折愈合时间为12～19周,平均16周。随访期内未见骨折固定位置发生改变,无内固定断裂、股骨头缺血坏死、手术切口感染等并发症发生。2例患者膝关节活动受限。结论高能量损伤造成股骨干骨折有合并同侧股骨颈骨折的可能,必要的影像检查可避免漏诊。采取恰当的内固定方法治疗,能得到满意疗效。

Objective To evaluate the clinical features and treatment methods of femoral shaft fractures incorporated with ipsilateral femoral neck fractures. Methods From May 2001 to September 2008,14 cases of ipsilateral fractures of femoral neck and shaft treated with surgical reduction and internal fixation were retrospectively analyzed. There were 9 males and 5 females. The causes of fractures were as follows： 13 cases of motor vehicle accidents, 1 caused by fallen. In cases of the femoral shaft fracture, 2 patients in proximal third ,9 patients occurred in the middle third, 3 patient in distal third. According to Garden classification for femoral neck fractures,there were 8 stage Ⅱ ,5 stage Ⅲ ,and 1 stage Ⅳ. There were 3 open fractures. The femoral shaft and neck fractures were stabilized with reconstruction interlocking nail in 4, with cannulated lag screws and retrograde interlocking intramedullary nail in 8 ,with dynamic hip screw system（DHS） in 2. Results The average duration of the follow-up was 18 months （range, 10 months to 5 years）. The femoral neck fracture was initially overlooked in 3 cases （21.4%）. Mean time for union of the femoral neck fracture was 16 weeks（ranging 12 to 19 weeks） for the femoral shaft fracture was 18 weeks（ranging 14 to 22 weeks）. No severe complications were observed during the follow,up period. Conclusion In case of femoral shaft fracture resulted from high-energy trauma, diagnostic imaging should be taken, which can effectively avoid or minimize miss diagnosis. Complex ipsilateral femoral neck and shaft fractures should be timely surgical treated through rational and reliable internal fixation, which can attain early satisfactory clinical results.