股骨干骨折合并同侧股骨颈骨折手术方法的选择及疗效分析

Treatment of ipsilateral fractures of femoral shaft and neck

目的 探讨股骨干骨折合并同侧股骨颈骨折的手术方法及疗效。方法2004年11月至2009年11月共收治42例股骨干骨折合并同侧股骨颈骨折患者，男37例，女5例；年龄21～84岁，平均59．2岁。股骨干骨折部位：近段18例，中段17例，远段7例。股骨颈骨折按Garden分型：I型5例，Ⅱ型10例，Ⅲ型21例，Ⅳ型6例。本组患者均于入院后3d内确诊，无误诊及漏诊。其中20例患者行人工关节置换治疗，为关节置换组；22例患者行空心钉、髓内钉或钢板内固定，为内固定组。回顾性分析并比较两组患者的疗效。结果 42例患者术后获1～3年（平均2年）随访。股骨干骨折愈合时间为14～24周，平均18周；股骨颈骨折愈合时间为12～20周，平均16周。两组患者平均住院时间、手术时间、术中出血量、术后下床活动时间差异均有统计学意义（P〈0．05）。关节置换组术后髋关节功能优良率为95．0％，内固定组术后髋关节功能优良率为72．7％，差异有统计学意义（X^2=9．251，P=0．000）。两组未发生并发症的患者术后1、2、3年Merehan评分比较差异均无统计学意义（P〉0．05）。结论 股骨干骨折合并同侧股骨颈骨折的治疗应根据患者的体质、年龄、股骨干骨折的部位及股骨颈骨折的移位程度来确定。对于年龄较大、体质较差的患者，行人工股骨头置换术是一种较好的选择。

Objective To investigate clinical features, operative treatments and outcomes of ipsi- lateral fractures of femoral shaft and neck. Methods Forty-two cases of ipsilateral fractures of femoral neck and shaft were treated from November, 2004 to November, 2009 in our institution. They were 37 males and 5 females. Their ages ranged from 21 to 84 years, with an average of 59.2 years. The fracture involved 18 upper shafts, 17 middle shafts and 7 lower shafts. By Garden classification, there were 5 cases of type I, l0 cases of type H, 21 cases of type HI, and 6 cases of type 1V neck fractures. All cases were diagnosed in 3 days after admission; there were no misdiagnosis or missed diagnosis. Twenty patients were treated by artificial joint replacement （replacement group）, while 22 patients by fixation with cannulated nails, intramedullary nails, or plate （fixation group）. Outcomes were compared between the 2 groups. Results All cases were followed up for 1 to 3 years, with an average of 2 years. Femoral neck fractures united between 12 to 20 weeks, with an average of 16 weeks; femoral shaft fractures united between 14 to 24 weeks, with an average of 18 weeks. There were significant differences between the 2 groups in average length of hospital stay, ambu- lation time, blood loss, postoperative activities and good to excellent rate of postoperative joint function （ P 〈 0. 05）. There were no significant differences between the 2 groups in the Merchan scores 1, 2, and 3 years after operation for complication-free patients （ P 〉 0.05）. Conclusion Surgical treatment of ipsilateral frac- tures of femoral neck and shaft depends on position of the shaft fracture, displacement of the neck fracture, physical constitution and age of the patient to be treated.