下肢骨干骨折同时伴同侧髋和膝关节损伤的临床特点

THE CLINICAL CHARACTERS OF SHAFT FRACTURES OF LOWER EXTREMITIES ASSOCIATED WITH IPSILATERAL HIP AND KNEE JOINT INJURIES

目的 探讨下肢骨干骨折同时伴发同侧髋和膝关节损伤的临床特点。方法 复习 8例下肢骨干骨折同时伴发同侧髋和膝关节损伤病例 ,总结其受伤机制、漏诊或延迟诊断原因与特点及其治疗方法与结果。结果 8例均为交通伤和高能量损伤 ;漏诊 5例 ,延迟诊断 1例 ,漏诊和延迟诊断率为 75 % ;其中 5例股骨颈骨折漏诊或延迟诊断 4例 ,4例后交叉韧带损伤漏诊 2例。经 6个月～ 2 .5年(平均 1 5个月 )的随访 ,8例股骨和胫骨折均完全愈合 ,1例膝关节失稳 ,1例下肢短缩 2cm其余病例髋、膝关节功能均良好。结论 下肢骨干骨折同时伴发同侧髋和膝关节损伤机制复杂且外伤能量高 ;较之下肢骨干骨折单纯伴发同侧髋或膝关节损伤更易漏诊或延迟诊断 ;在抢救生命的同时 ,及时行股骨和胫骨折的内固定 ,并同时处理同侧髋和膝关节损伤 ,可提高临床疗效。

Objective To investigate the clinical characters of shaft fracture of lower extremities associated with ipsilateral hip and knee joint injures. Methods 8 patients with shaft fractures of lower extremities associated with ipsilateral hip and knee joint injuries were reviewed, the mechanisms of injury, misdiagnose causes and treatments were discussed. Results All cases were vehicle drivers and suffered from high energy injuries. Of 8 cases ,5 were miss-diagnosed and 1 was delay diagnosed, misdiagnosed rate was 75%. 2 of 4 femoral neck fractures were missed or delay diagnosed. All cases healed had been follown-up for average 15 months(range from 6 months to 2.5 years). Conclusion To compare with shaft fractures of lower extremities associated only with ipsilateral hip or knee joint injures, the mechanisms of shaft fractures of lower extremities associated with ipsilateral hip and knee joint injures are complex. The diagnosis is susceptible to be delayed or missed. The clinical effect will be improved if shaft fractures of lower extremities are given internal fixation and hip or knee injures are promptly treated while performing life savings.