股骨干骨折合并同侧股骨颈骨折的手术治疗方法及临床疗效

Surgical Treatment for Ipsilateral Fractures of Femoral Neck and Shaft

目的：观察并分析股骨干骨折合并同侧股骨颈骨折的手术治疗方法及临床疗效。方法：回顾性分析2012年1月-2015年2月笔者所在医院收治的50例股骨干骨折合并同侧股骨颈骨折的患者,44例在手术前诊断为股骨干骨折合并同侧股骨颈骨折,其中采用股骨髓内钉重建同时固定股骨颈骨折和股骨骨干骨折有32例,采用钢板固定股骨干骨折、空心螺钉固定股骨颈骨折有12例;有3例在手术前只诊断了股骨干骨折而漏诊了股骨颈骨折,手术采用髓内钉进行固定,手术后发现合并患有股骨颈骨折,2例采用空心螺钉加以治疗,4例采取重建髓内钉的治疗方法。结果：对术后患者进行随访,时间为1~4年,平均1.4年。48例患者的骨折在术后15~31周愈合,平均时间为19周;2例患者股骨干骨折在术后1年仍没有愈合,进行再次植骨手术后24周愈合;25例患者均没有发生股骨头坏死。结论：采用手术治疗股骨干骨折合并同侧股骨颈骨折时,只要严格按照操作规范并选用合适的固定材料,都可以获得较好的治疗效果。

Objective： To observe and explore the effect of surgical treatment on patients with ipsilateral femoral neck and shaft fractures.Method： A retrospective study of 50 cases with ipsilateral femoral neck and shaft fractures from January 2012 to February 2015 was done.Among the 44 cases who were clearly diagnosed before operation, 32 cases were given reconstruction nailing of both shaft and neck, 12cases were given cancellous screw fixation for the neck and limited contact dynamic compression plate （LC-DCP） fixation for the shaft. Both of the 6 cases who were misdiagnosed before the first operation were fixed with intrameduiiary nail originally. After ipsilateral femoral neck fracture was diagnosed, second operations were done to them. Two cases was fixed with cancellous screw, 4 cases was fixed with reconstruction nail.Result： All cases have been followed up for 1 to 4 years （ with an average of 1.4 years ）. The femoral shaft fractures were healed at 15~31 weeks （ with an average of 19 weeks ） after operation in 48 cases. The femoral shaft fractures failed to heal in 2 cases even at 1 year after the operation, and after bone grafting, the patient was healed 24 weeks later. Femoral head necrosis did not occur in any cases. Conclusion： Satisfactory clinical effect can be achieved through rational and reliable internal fixation in ipsilateral femoral shaft and neck fractures.