带锁髓内钉治疗股骨干骨折合并股骨颈及转子间骨折或转子下粉碎骨折

The treatment of femoral shaft fractures with ipsilateral femoral neck or peritrochanteric fractures using intramedullary interlocking nail

目的应用带锁髓内钉治疗股骨干骨折合并同侧股骨颈骨折及转子间骨折或转子下粉碎骨折。方法在1996年7月～1998年11月收治的16例复杂股骨骨折中，股骨干骨折合并同侧股骨颈骨折3例，合并转手间骨折4例，转子下粉碎骨折9例。其中10例应用国产加长型Gamma钉，6例使用Russell－Taylor股骨重建钉固定。结果所有病例随访6～22个月，平均11个月。除1例股骨干骨折合并同侧股骨颈骨折患者术后7个月出现股骨头坏死外，其余15例骨折均愈合，平均愈合时间5．5个月，患肢关节功能优良。经此方法治疗后可早期活动关节及功能锻炼、手术创伤小、切口小、固定可靠、骨折愈合率高。结论 对股骨干骨折合并同侧股骨颈骨折及转手间骨折或转子下粉碎骨折的治疗，带锁髓内钉具有明显优势。

Objective To analyze and evaluate the efficacy of intramedullary interlocking nail in thetreatment of femoral shaft fractures with ipsilateral femoral neck or peritrochanteric fractures and comminutedsubtrochanteric fractures. Methods From July 1996 to November 1998, 16 cases of complex femoralfractures were treated with Long - Gamma nail or Russell - Taylor reconstruction nail. Three patients wereassociated with ipsilateral femoral neck fractures, four with ipsilateral intertrochanteric fractures, and nine with comminuted subtrochanteric fractures. Results The follow-up ranged from 6 to 22 months with an average of 11 months. All the fractures healed up well except one ipsilateral femoral neck fracture. Ischemic femoral necrosis happened in this patient seven months after operation. The average fracture healing time 5. 5 months.Joints movement and functions were excellent. Conclusion Long - Gamma nail and Russell - Taylor reconstruction nail had obvious advantage of less trauma, short incision, reliable fixation, high rate of fracture healing. It appears to be a method of choice in the treatment of complex femoral fractures.