同侧股骨颈和股骨干骨折：两种治疗方法的回顾性分析。
Ipsilateral femoral neck and shaft fractures: a retrospective analysis of two treatment methods.
机构信息
Department of Orthopaedic Surgery, Paraplegia and Rehabilitation, Pt. B.D. Sharma PGIMS, 9-J/52, Medical Enclave, Rohtak, 124001, Haryana, India,
出版信息
J Orthop Traumatol. 2008 Sep;9(3):141-7. doi: 10.1007/s10195-008-0025-3. Epub 2008 Aug 7.
BACKGROUND
No consensus exists regarding the optimal treatment of ipsilateral femoral neck and shaft fractures. The three major issues related to these fractures are the optimal timing of surgery, which fracture to stabilize first, and the optimal implant to use. In an effort to find answers to these three key issues, we report our experience of managing 27 patients with ipsilateral femoral neck and shaft fractures by using two different treatment methods, i.e., reconstruction-type intramedullary nailing and various plate combinations.
MATERIALS AND METHODS
We divided patients into two groups. Group I included 15 patients (13 males and 2 females) who were operated with cancellous lag screws or dynamic hip screws (DHS) for fractured neck and compression plate fixation for fractured shaft of the femur. Group II included 12 patients (11 males and 1 female) who were operated with reconstruction-type intramedullary nailing.
RESULTS
Mean age was 33.2 and 37.9 years in group I and II, respectively. Mean delay in surgery was 5.9 and 5.4 days in group I and II, respectively. Average union time for femoral neck fracture in groups I and II were 15.2 and 17.1 weeks, respectively; and for shaft fracture these times were 20.3 and 22.8 weeks, respectively. There were 13 (86.6%) good, 1 (6.7%) fair and 1 (6.7%) poor functional results in group I. There were 10 (83.3%) good, 1 (8.3%) fair and 1 (8.3%) poor functional results in group II.
CONCLUSIONS
Both of the treatment methods used in the present study achieved satisfactory functional outcome in these complex fractures. Fixation with plate for shaft and screws or DHS for hip is easy from a technical point of view. Choice of the treatment method should be dictated primarily by the type of femoral neck fracture and the surgeon's familiarity with the treatment method chosen. The femoral neck fracture should preferably be stabilized first, and a delay of 5-6 days does not affect the ultimate functional outcome.
背景
对于同侧股骨颈和股骨干骨折，目前尚无统一的治疗方案。这些骨折主要涉及三个问题，分别为手术时机、优先固定哪部分骨折、以及选择哪种植入物。为了回答这三个关键问题，我们报告了使用两种不同治疗方法（重建型髓内钉和各种钢板组合）治疗 27 例同侧股骨颈和股骨干骨折患者的经验。
材料和方法
我们将患者分为两组。第 I 组包括 15 例患者（男 13 例，女 2 例），采用空心拉力螺钉或动力髋螺钉（DHS）固定股骨颈骨折，采用加压钢板固定股骨干骨折。第 II 组包括 12 例患者（男 11 例，女 1 例），采用重建型髓内钉治疗。
结果
第 I 组和第 II 组患者的平均年龄分别为 33.2 岁和 37.9 岁。第 I 组和第 II 组患者的手术延迟时间分别为 5.9 天和 5.4 天。第 I 组和第 II 组患者股骨颈骨折的平均愈合时间分别为 15.2 周和 17.1 周；股骨干骨折的愈合时间分别为 20.3 周和 22.8 周。第 I 组患者中有 13 例（86.6%）功能恢复良好，1 例（6.7%）为一般，1 例（6.7%）为较差。第 II 组患者中有 10 例（83.3%）功能恢复良好，1 例（8.3%）为一般，1 例（8.3%）为较差。
结论
本研究中使用的两种治疗方法均能使复杂骨折获得满意的功能结果。从技术角度来看，钢板固定股骨干和螺钉或 DHS 固定髋关节较为容易。治疗方法的选择应主要取决于股骨颈骨折的类型和术者对所选治疗方法的熟悉程度。应优先固定股骨颈骨折，5-6 天的延迟不会影响最终的功能结果。
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