接骨板系统治疗同侧股骨干合并股骨近端骨折

Efficacy of plate system in the treatment of ipsilateral proximal femur and shaft fractures

背景:股骨干合并同侧股骨近端骨折是一种较为少见的损伤,漏诊率高,尚无统一标准的内固定方式。目的:探讨接骨板系统治疗同侧股骨干合并股骨近端骨折的疗效。方法:回顾性分析2012年1月至2015年12月收治的16例同侧股骨干合并股骨近端骨折患者,男11例,女5例;年龄17~60岁,平均(36.2±10.7)岁;交通伤12例,高处坠落伤4例;闭合性骨折14例,开放性骨折2例(GustiloⅡ型1例,Ⅲ型1例)。入院后即刻确诊股骨近端骨折13例,延迟诊断3例,延迟时间为5~6 d。全部病例均采用接骨板系统(桥接组合式内固定系统联合重建锁定接骨板或空心钉)固定治疗。结果:手术时间为135~231 min,平均(179.7±26.3)min;术中出血量为430~575 ml,平均(497.8±40.1)ml。除1例失随访外,其余病例均获得随访,随访时间为9~30个月,平均(16.2±6.1)个月。14例股骨近端骨折于术后3~6个月获得骨折愈合,平均(4.2±0.9)个月;1例股骨颈骨折术后9个月仍未愈合,行股骨转子间外翻截骨后5个月愈合。14例股骨干骨折于术后3~7个月获得骨折愈合,平均(5.1±1.1)个月;1例股骨干骨折术后9个月骨折仍未愈合,经再次手术内固定并植骨后4个月愈合。末次随访的Friedman-Wyman功能评分:优9例,良5例,差1例。术后并发症包括伤口感染1例,股骨颈内翻畸形1例,股骨颈骨不连1例,股骨干骨不连1例,股骨头缺血性坏死1例。结论:同侧股骨干合并股骨近端骨折相对较少,漏诊率和延迟诊断率较高,且治疗复杂。应用接骨板系统治疗同侧股骨干合并股骨近端骨折的临床效果良好。

Background： Ipsilateral proximal femur and shaft fractures are rare, therefore the incidence of missed diagnosis is relatively high, and there is still no recognized standard internal fixation method. Objective： To discuss the efficacy of the plate system on ipsilateral fractures of proximal femur and shaft. Methods： From January 2012 to December 2015, 16 patients with ipsilateral proximal femur and shaft fractures, including 11 males and 5 females, with the mean age of（36.2 ±10.7） years old（range, 17-60 years） were retrospectively reviewed. The causes of the fractures were traffic accident in 12 patients and falling injuries in 4 patients. There were 14 patients of closed fractures and 2 patients of open fractures（1 patient of Gustilo Ⅱ and 1 patient of Gustilo elayed in 3 patients asⅢ）. The proximal femur fracture was diagnosed in emergency in 13 patients, and the diagnosis was d the delayed time of 5-6 days. All patients were treated with plate system as bridge plate combining with reconstructing locking plates or cannulated screws. Results： The mean operation time was（179.7 ±26.3） min（range, 135-231 min）. The intraoperative blood loss volume ranged from 430 to 575 ml with an average of（497.8±40.1） ml. All patients except for one withdrawing were followed up for an average of（16.2 ± 6.1） months（range, 9-30 months）. The proximal femur fractures were healed within 3-6 months in 14 patients with the mean time of（4.2 ± 0.9）months. One patient with femoral neck fracture had not healed for 9 months after the operation and recovered 5 months after valgus intertrochanteric osteotomy instead. The femoral shaft fractures obtained rigid union in 14 patients within 3-7 months after the operation with an average of（5.1±1.1） months. One patient endured nonunion for 9 months after the operation, and healed 4 months after the revision surgery and iliac bone grafting. According to Friedman and Wyman classification, 9 patients had a good functional result, 5 patients was fair, and one patient was poor at the final follow-up. The complications included wound infection in one patient, varus angulation of femoral neck in one patient, nonunion of femoral neck fracture in one patient, nonunion of femoral shaft fracture in one patient and osteonecrosis of femoral head in one patient.Conclusions： The ipsilateral fractures of proximal femur and shaft are rare and complicated, and have high incidences of miss and delayed diagnosis, which can be treated with plate system for its good clinical efficacy.