股骨颈伴同侧股骨转子间骨折的分型及治疗方式选择

Classification and treatment strategy of femoral neck fracture with ipsilateral intertrochanteric fracture

目的探讨股骨颈伴同侧股骨转子间骨折的分型及治疗方式选择。方法回顾性分析2003年3月至2019年3月期间首都医科大学良乡教学医院骨科收治的44例股骨颈伴同侧股骨转子间骨折患者资料。男19例,女25例;年龄为37~93岁,平均77.9岁。按照股骨颈骨折的解剖位置、移位程度将此类骨折分为3型,而股骨转子间骨折可以为稳定或不稳定型骨折:Ⅰ型骨折3例(完全囊外型),Ⅱ型骨折31例(囊内稳定型),Ⅲ型骨折10例(囊内不稳定型)。Ⅰ、Ⅱ型骨折采用髓内钉固定治疗,Ⅲ型骨折采用骨水泥型半髋关节置换+转子部骨折复位克氏针、钢缆固定治疗。记录患者的骨折愈合时间、患髋功能及并发症发生情况等。结果44例患者术后获至少2年随访。3例Ⅰ型骨折患者骨折愈合时间平均为5.6个月(4.4~6.8个月),末次随访时根据髋关节Harris评分标准评定患髋功能:优2例,良1例。31例Ⅱ型骨折患者中,30例患者的骨折愈合时间平均为7.2个月(5.1~9.3个月);末次随访时患髋功能:优18例,良6例,可5例,差2例,优良率为77.4%(24/31);并发症发生情况:头钉退出或切割6例,感染1例,骨不连1例。10例Ⅲ型骨折患者末次随访时患髋功能:优7例,良2例,差1例。结论对于Ⅰ、Ⅱ型股骨颈伴同侧股骨转子间骨折,具有成角稳定的髓内固定是较佳选择;而对于Ⅲ型骨折,髋关节置换应作为首选。

Objective To explore the classification and treatment strategy of femoral neck fracture combined with ipsilateral intertrochanteric fracture.Methods A retrospective analysis was performed of the 44 patients who had been admitted to Department of Orthopedics,Liangxiang Teaching Hospital,Capital Medical University from March 2003 to March 2019 for femoral neck fracture combined with ipsilateral intertrochanteric fracture.They were 19 males and 25 females,aged from 37 to 93 years(average,77.9 years).According to the anatomical location and displacement severity,the femoral neck fractures were divided into 3 types while the intertrochanteric fractures were classified as stable or unstable ones.There were 3 cases of typeⅠwhich were completely extracapsular ones,31 cases of typeⅡwhich were intracapsular stable ones,and 10 cases of typeⅢwhich were intracapsular unstable ones.TypesⅠandⅡfractures were treated with intramedullary fixation,and typeⅢfractures with cemented hip hemi-replacement+reduction and fixation of the intertrochanteric fracture with Kirschner wires and steel cables.Recorded were fracture healing time,function of the affected hip and complications.Results The 44 patients were followed up for at least 2 years.The fracture healing time for the 3 patients with type I fracture averaged 5.6 months(from 4.4 to 6.8 months);their hip function at the last follow-up,evaluated by the Harris scoring system,was excellent in 2 cases and good in one case.For 30 of the 31 patients with typeⅡfracture,the fracture healing time averaged 7.2 months(from 5.1 to 9.3 months);their hip function at the last follow-up,evaluated by the Harris scoring system,was excellent in 18 cases,good in 6 cases,fair in 5 cases,and poor in 2 cases,giving an excellent and good rate of 77.4%(24/31).As for complications,withdrawal or cutting-out of the head screw happened in 6 cases,infection in one case and nonunion in one case.In 10 patients with typeⅢfracture,the hip function at the last follow-up was excellent in 7 cases,good in 2 cases and poor in one case.Conclusions For typeⅠand typeⅡfemoral neck fractures combined with ipsilateral intertrochanteric fracture,intramedullary fixation with angulation stability may be a proper choice.For typeⅢones,hip joint replacement should be the first choice.