同侧股骨干合并股骨颈骨折的处理

The management of femoral shaft fractures with ipsilateral femoral neck fractures

目的分析同侧股骨干合并股骨颈骨折的临床特点和诊断要点,探讨不同治疗方法的疗效。方法1998年3月～2001年6月收治的18例19个同侧股骨干合并股骨颈骨折病人中,早期诊断12例,7例用逆行带锁髓内钉+空心螺钉,2例用股骨重建钉固定,3例用钢板及多针固定。股骨颈骨折7例漏诊,2例用多针固定。2例行缝匠肌带肌蒂植骨,3例行带旋髂深血管植骨术。结果术后随访8～40个月,平均16个月。股骨干骨折除1例钢板固定不愈合外其余均愈合。股骨颈骨折1例不愈合,其余均愈合。结论对股骨干骨折合并同侧股骨颈骨折早期推荐使用逆行带锁髓内钉和空心螺钉固定,对漏诊病例使用多针在股骨髓内钉前方固定股骨颈是一种有效的补救方法,晚期漏诊采用带肌蒂、血管蒂植骨术仍可取得较高愈合率。

Objective To analyze the clinical characteris tics and diagnostic outline and to elucidate the effects of different managements of femoral shaft fractures with ipsila teral femoral neck fractures.Methods A retrospective study was carried out in 18patients with ipsilateral femo ral neck and femoral shaft fractures from 1998to 2001,and their managements and final clinical outcomes were reviewed.Results The follow -up ranged from8to 40months with an average of 16mon ths.All the fractures united except one femoral shaft fracture and one femoral neck fracture.Conclusion Retrograde intramedullary nailing with multiple cancellous screws to t reat ipsilateral femoral neck and femora l shaft fractures has been proved an e ffective technique.For the cases overlooked initially,treatment with multiple nailing around the intramedullary n ail is a good choice.[