同侧股骨干合并股骨颈骨折手术治疗.docVIP

同侧股骨干合并股骨颈骨折手术治疗 　【摘要】 目的 探讨同侧股骨干合并股骨颈骨折的临床特点及治疗方法。方法 选择2000年2月至2006年4月，14 例经手术复位内固定治疗的同侧股骨干合并股骨颈骨折患者进行回顾性分析，其中股骨颈骨折漏诊4 例，采用股骨重建髓内钉固定4 例，股骨逆行交锁髓内钉及空心螺钉固定5 例，股骨交锁髓内钉结合空心螺钉固定2 例，股骨干骨折加压钢板及空心钉固定3 例。结果 本组14 例均获随防，随访时间为12～48个月，平均27个月。14 例股骨干骨折均在术后7个月内获得愈合，股骨颈骨折在6个月内愈合。无切口感染、血管神经损伤、内固定断裂及股骨头缺血性坏死等并发症发生。所有患者髋关节功能的恢复无活动障碍，膝关节活动受限1 例。结论 同侧股骨干合并股骨颈骨折时股骨颈骨折常常无移位或轻度移位，其漏诊率高，在骨折治疗的微创理念指导下，运用医生熟练掌握的内固定方法，经过合理的术后功能锻炼，可获得满意的临床疗效。 【关键词】 股骨骨折 股骨颈骨折 骨折固定术 内固定 Surgical Treatment for Ipsilateral Fractures of Femoral Neck and Shaft Abstract：Objective To explore the clinical features and operative methods of ipsilateral fractures of femoral neck and shaft.Methods From February 2000 to April 2006，14 patients of ipsilateral fractures of femoral neck and shaft were treated by open reduction and internal fixation.All patients were reviewed retrospectively.The diagnosis of four femoral neck were missed out.Among the 14 patients，4 patients were treated with reconstructive intramedullary nail to fix both shaft and neck fractures，5 patients were treated with retrograted intramedullary nail to fix both shaft and neck fractures，2 patients were treated with intramedullary nail to fix shaft fractures and with cannulated screws to fix neck fractures，3 patients were treated with dynamic compression plate to fix shaft fractures and with canulated screws to fix neck fractures.Results 14 patients were followed up for 12～48 months，average 27 months.All femoral shaft fractures were united during 7 months，and all neck fractures were united during 6 months.There were no infection，nerve damage，hardware failure and osteonecrosis of femoral head.The hip and knee joints recovered well.Conclusion The ipsilateral fracture of femoral neck and shaft is easy to miss diagnosis during the early stage after injury.Minimally invasive surgical fixation should be applied with selection of different methods for different types.These fractures should be treated with open reduction and internal fixation，and reasonable exerc