股骨干骨折合并同侧股骨颈或股骨髁上骨折漏诊的诊治

Analysis of misdiagnoses for femoral shaft fracture with ipsilateral femoral neck or femoral fractures

目的对股骨干骨折合并同侧股骨颈或股骨髁上骨折漏诊的治疗进行分析。方法2002年12月至2008年12月安徽医科大学附属省立医院骨科收治8例股骨干合并同侧股骨颈或股骨髁上骨折漏诊患者，年龄25～59岁，平均41．7岁，初步诊断为股骨干骨折，后修正为股骨干合并同侧股骨颈或股骨髁上骨折。股骨干骨折行钢板内固定，股骨颈骨折行3枚空心加压螺丝钉内固定；股骨髁上骨折2例行股骨远端外髁解剖钢板的内固定，1例术中更改行逆行股骨交锁髓内钉内固定。结果术后平均随访3．5年，骨折均愈合，髋膝关节功能良好。结论凡强大暴力及有扭转暴力者股骨干合并同侧股骨颈或股骨髁上骨折易漏诊，术前常规髋膝摄片是避免漏诊的有效方法。

Objective To analyze the misdiagnoses of femoral shaft fracture combined with ipsilateral femoral neck or femoral fractures. Methods Over the past six years, eight misdiagnosed cases of ipsilateral femoral neck or femoral fractures missed patients, aged 25 to 59 years old （mean： 41.7 ） , were treated at our department. An initial diagnosis of femoral shaft fracture was later revised as ipsilateral femoral shaft with supra-condylar fracture of femoral neck or femur. Femoral shaft fracture was fixed with armor plate, 3-screw hollow compression fixation of femoral neck ; two cases of femoral condylar fractures of distal femoral condyle with anatomical plate fixation and 1 case of intraoperative change into the retrograde femoral intramedullary nail fixation. Results The mean post-operative follow-up was 3.5 years. All fractures healed with excellent hip and knee functions. Conclusion For those with a strong reverse and torsional violence, femoral shaft fracture combined with ipsilateral femoral neck or femoral fractures may be easily misdiagnosed. A preoperative conventional hip-knee X-ray film is an effective way to avoid a misdiagnosis.