同侧股骨干股骨颈骨折

Ipsilateral femoral neck and shaft f ractures

目的探讨同侧股骨干、股骨颈骨折的临床特点及诊断要点。方法对1995年5月～1999年5月间治疗的初诊时未诊断出股骨颈骨折的7例同侧股骨干合并股骨颈骨折的骨折类型、膝关节合并损伤、股骨颈骨折诊断时间、治疗方法、随访结果等进行了回顾性研究。结果7例股骨干骨折均发生于中1/3,股骨颈骨折均为基底型,2例合并膝关节其他骨折,股骨颈骨折诊断延误时间1～75d,除1例保守治疗外,其余6例股骨干骨折及5例股骨颈骨折均行手术治疗,另1例股骨颈骨折确诊时已近临床愈合。平均随访时间15.6个月,7例股骨颈及股骨干骨折均获得愈合,2例股骨颈骨折畸形愈合。所有患者随诊时均未发现股骨头有缺血性坏死的表现。结论对高能损伤造成的股骨干骨折患者应常规拍摄骨盆前后位X线片。对髋关节X线片表现阴性,但股骨干骨折内固定之后仍主诉髋关节疼痛的患者应进行动态检查。一旦发现合并股骨颈骨折应争取早期复位内固定,手术治疗效果优于非手术治疗。

Objective To elucidate the clinical characteristics and diagnostic outline of ipsilateral femoral neck and shaft fractures.Methods A retrospective study was carried ou t on 7patients with ipsi-lateral femoral neck and shaft fractures associated injuries of the knee;the duration of delay in diagnosis o f the femoral neck fractures,the managem ent of treatment and final clinical o utcomes were reviewed.Results All of the femoral shaft fractures occur red in the middle third and the femora l neck fractures in the base of the neck.Two patients were associated w ith knee injuries.The duration of delay in diagnosis of the femoral neck fractures ranged from 1to 75days.Si x femoral shaft fractures and 5neck f ractures were treated operatively.The mean follow-up period was 15.6mo nths,and all of the shaft and neck fra ctures were eventually healed without the evidence of avascular necrosis of the femoral head in spite of2mal-unions of the femoral neck.Conclusion In case of femoral shaft fracture resulting from high-energy trauma,an A-P pelvic film should be routinely taken.The patients with negative findings on the hip radiographs continue to complain of hip pain following open reduction and intern al fixation of the femoral shaft fractures should undergo CT or MR imaging examination.Once the femoral neck f racture is recognized,operative re duction and fixation should be em-ployed immediately.The outcome of o perative treatment is much superior to that of non-operative.