不同内固定方法治疗股骨干合并同侧股骨颈骨折的临床疗效分析

The analysis of surgical treatment for ipsilateral fractures of femoral neck and shaft

目的探讨不同内固定方法治疗股骨干合并同侧股骨颈骨折的临床疗效。方法 24例股骨干合并同侧股骨颈骨折患者中采用动力髋螺钉(DHS)固定5例,加压钢板加空心加压螺钉固定8例,重建髓内钉固定5例,顺行髓内钉加空心加压螺钉固定6例。比较上述几种内固定治疗方法的临床效果。结果术后随访32～60个月,平均40个月。21例股骨颈骨折平均愈合时间4.2个月,3例股骨颈骨折不愈合。24例股骨干均愈合,平均愈合时间5.8个月。未用克氏针临时固定股骨颈骨折12例中,3例出现股骨颈不愈合,4例轻度髋内翻畸形。结论加压钢板加空心加压螺钉固定治疗股骨干合并同侧股骨颈骨折简便易行,在实施固定术前用克氏针临时固定股骨颈骨折可避免股骨颈骨折再移位和损伤。

Objective To investigate the curative effect of different internal fixation for ipsilateral fractures of the femoral neck and shaft.Methods 24 patients sustained ipsilateral femoml shaft and neck fractures were stabilized with dynamic hip screw system in 5 cases,with dynamic compression plate and cannulated lag screw in 8 cases,with constructive nail in 5 cases,with antegrade intramedullary locking nail and cannulated lag screw in 6 cases.The clinical efficacy were observed.Results A1l of the patients were followed up for 32 to 60 months,with an average of 40 months.The average healing period of femoral neck fracture was 4.2 months in 21 cases,nonunion of femoral neck fractures in 3 cases.The average healing period of femoral shaft fracture was 5.8 months in 24 cases.In 12 cases that not using temporary fixation of femoral neck with Kirschner wire,there were nonunion of femoral neck in 3 cases and slight coxa vara in 4 cases.Conclusion The fixation with dynamic compression plate and cannulated lag screw is a handy method to treat ipsilateral fracture of the femoral neck and shaft.It would be avoided to the replacement and trauma,temporary fixing the fracture with Kirschner wire before the pexia of the femoral neck fracture.