股骨干骨折合并同侧股骨颈骨折的诊治进展

Progress in diagnosis and treatment of ipsilateral femoral neck and shaft fracture

股骨干骨折合并同侧股骨颈骨折临床较为少见，多由高能量暴力导致，胸腹器官损伤、颅脑损伤、其他部位骨折等合并伤较多，同侧股骨颈骨折延迟诊断或漏诊比例高。接诊高能量损伤导致的股骨干骨折患者时，需进行全面细致的体检，除股骨干骨折外，还应加拍患侧髋、膝关节X线片。拍摄股骨近端X线片时注意前倾角的影响，必要时行髋部CT扫描和MRI检查，以早期准确诊断。根据患者年龄、身体状况、合并伤及骨折部位、类型和严重程度等综合评估，制定合理的手术方案，术中注意对骨折（尤其是股骨颈骨折）解剖复位，选择合适的内固定物固定。同时需重视对合并损伤的治疗以及并发症的防治。

Ipsilateral femoral neck and shaft fractures are rare injuries, which are often caused by high-energy trauma and combined with multiple injuries, such as thoracic and abdominal injury, head injuries, and fractures of other sites. Delayed or missed diagnosis of the ipsilateral femoral neck fracture often occurs. When patients with femoral shaft fractures caused by high-energy trauma are admitted into hospital, physical examination should be conducted carefully. In addition to femoral shaft fractures, radiographs of the ipsilater hip and knee joints should been taken, simultaneously taking into consideration the potential effect of anteversion angle on the demonstration of femoral neck fracture. Computed tomograph and magnetic resonance imaging are advised to perform if necessary to facilitate early and accurate diagnosis of ipsilateral femoral neck fracture. Comprehensive evaluation should be done based on age, physical condition, associated injuries as well as fracture site, classification and injury severity. Accordingly, proper and reasonable surgical plan is made. During the operation, anatomical reduction of the fractures, especially femoral neck fractures, should be achieved,and then fixed with appropriate internal implants. Besides, attention should also be paid to the treatment of associated injuries as well as the prevention and management of complications.