股骨干合并同侧股骨颈骨折长髓内钉InterTAN与逆行髓内钉结合空心拉力螺钉内固定的对照研究

Control study of long intramedullary nail InterTAN and retrograde intramedullary nail combined with cannulated lag screw fixation for ipsilateral femoral shaft and neck fractures

目的探讨长髓内钉InterTAN与逆行髓内钉结合空心拉力螺钉治疗股骨干合并同侧股骨颈骨折的特点,为临床应用提供参考。方法 2006年1月～2010年9月应用两种内固定系统治疗股骨干合并同侧股骨颈骨折21例,长髓内钉InterTAN组12例,逆行髓内钉结合空心拉力螺钉组9例,其中术前漏诊1例。结果 21例全部获得随访,随访时间11～26个月,平均(17.3±0.6)个月。长髓内钉InterTAN组骨折愈合时间:股骨颈平均13.8周,股骨干平均16周,Harris评分标准优良率为83.33%。逆行髓内钉结合空心拉力螺钉组骨折愈合时间:股骨颈平均14.1周,股骨干平均16.2周,Harris评分标准优良率为77.78%。结论长髓内钉InterTAN与逆行髓内钉结合空心拉力螺钉治疗效果相当,但髓内钉InterTAN具有操作简便、切口小、软组织损伤小、并发症风险低等优点;而逆行髓内钉结合空心拉力螺钉可作为漏诊后简单易行的补救方法。

Objective To investigate the clinical features of long intramedullary nail InterTAN and retrograde in- tramedullary nail combined with cannulated lag screw fixation in the treatment of ipsilateral femoral shaft and neck frac- tures, to provide references for clinical application. Methods Twenty-one cases with ipsilateral femoral shaft and neck fractures were treated by two different internal fixation systems from January 2006 to September 2011. There were 12 cases of long intramedullary nail InterTAN group and 9 cases of retrograde intramedullary nail combined with cannulated lag screw group, among which, one case was missed diagnosed before the operation. Results All of 21 patients were followed up for 11-16 months, （17.3_＋0.6） months in average. The fracture healing time in long intramedullary nail InterTAN group： which of femoral neck was 13.8 weeks, femoral shaft was 16 weeks, the excellent and good rate by Harris marking scheme was 83.33%. The fracture healing time in retrograde intramedullary nail combined with cannulated lag screw group： which of femoral neck was 14.1 weeks, femoral shaft was 16.2 weeks, the excellent and good rate by Harris marking scheme was 77.78%. Conclusion The effect of long intramedullary nail InterTAN and retrograde intramedullary nail combined with cannulated lag screw is similar. But intramedullary nail InterTAN has such advantages as easy handle, small incision, less soft tissue injury, lower complications risk, and so on. While retrograde intramedullary nail combined with cannulated lag screw can be used as a simple and practicable substituted method for misdiagnosis.