加长型PFNA治疗股骨干骨折伴同侧髋部骨折的临床观察

Clinical Investigations of Ipsilateral Hip and Femoral Shaft Fractures with Long Proximal Femoral Nail Antirotation

目的探讨股骨干骨折合并同侧髋部骨折的手术方法和疗效。方法分析自2006年10月至2009年6月应用手术治疗资料完整的20例股骨干骨折合并同侧髋部骨折患者,其中男16例,女4例;年龄27~57岁,平均42.6岁。股骨转子间骨折伴股骨干骨折10例,转子间骨折按Evans-Jensen分型,Ⅰ型1例,Ⅱ型3例,Ⅲ型2例,Ⅳ型4例;股骨颈骨折按G arden分型,Ⅰ型3例,Ⅱ型4例,Ⅲ型3例。17例患者伴有合并伤。结果本组随访12~24个月,平均21.5个月。所有股骨颈骨折均愈合,平均愈合时间为16周,无一例发生股骨头坏死;股骨转子间骨折平均愈合时间为16.2周;全部股骨干骨折均愈合,2例延迟愈合,平均愈合时间为22.2周。手术并发症4例。按F riedm an-W ym an评分标准评定,优14例,良4例,差2例,优良率90%。结论加长型PFNA是治疗股骨干骨折合并同侧髋部骨折可用的有效方法。

Objective The purpose of this study was to explore the operation method and functional outcome of patients with ipsilateral hip and femoral shaft fractures treated with long proximal femoral nail antirotation（PFNA-long）.Methods Between 2006.10 and 2009.6,20 cases with ipsilateral hip and femoral shaft fractures managed with PFNA-long were enrolled in this study.Associated injuries were present in 17 cases.The average follow-up period was 21.5 months.Results All femoral neck fractures achieved union without osteonecrosis of the femoral head,and all shaft fractures healed uneventfully except 2 case of delayed union.Mean union time of the femoral neck fractures was 16 weeks.Mean union time of the femoral shaft fractures was 22.2 weeks.Mean time to union of the femoral intertrochanteric fractures was 16.6 weeks.4 cases of intraoperative and postoperative complications were noted.Functional results using Friedman-Wyman Scores criteria were good in 14 cases,fair in 4 and poor in 2.Conclusion Reduction and internal fixation with PFNA-long was reliable and effective in the treatment of ipsilateral hip and femoral shaft fractures.