采用髋螺钉和扩髓逆行髓内钉治疗同侧股骨近端和股骨干骨折。
Ipsilateral proximal femur and shaft fractures treated with hip screws and a reamed retrograde intramedullary nail.
作者信息
Ostrum Robert F, Tornetta Paul, Watson J Tracy, Christiano Anthony, Vafek Emily
机构信息
Department of Orthopaedics, University of North Carolina, 3160 Bioinformatics Building, CB 7055, Chapel Hill, NC, 27599, USA,
出版信息
Clin Orthop Relat Res. 2014 Sep;472(9):2751-8. doi: 10.1007/s11999-013-3271-5.
BACKGROUND
Although not common, proximal femoral fractures associated with ipsilateral shaft fractures present a difficult management problem. A variety of surgical options have been employed with varying results.
QUESTIONS/PURPOSES: We investigated the use of hip screws and a reamed retrograde intramedullary (IM) nail for the treatment of this combined fracture pattern in terms of postoperative alignment (malunion), nonunion, and complications.
METHODS
Between May 2002 and October 2011, a total of 95 proximal femoral fractures with associated shaft fractures were treated at three participating Level 1 trauma centers; all were treated with hip screw fixation (cannulated screws or sliding hip screws) and retrograde reamed IM nails. The medical records of these patients were reviewed retrospectively for alignment, malunion, nonunion, and complications. Followup was available on 92 of 95 (97%) of the patients treated with hip screws and a retrograde nail. Forty were treated with a sliding hip screw, and 52 were treated with cannulated screws.
RESULTS
There were five proximal malunions in this series (5%). The union rate was 98% (90 of 92) for the femoral neck fractures and 91.3% (84 of 92) for the femoral shaft fractures after the initial surgery. There were two nonunions of comminuted femoral neck fractures after cannulated screw fixation. There was no difference in femoral neck union or alignment when comparing cannulated screws to a sliding hip screw. Four open comminuted femoral shaft fractures went on to nonunion and required secondary surgery to obtain union, and one patient developed symptomatic avascular necrosis.
CONCLUSIONS
The treatment of ipsilateral proximal femoral neck and shaft fractures with hip screw fixation and a reamed retrograde nail demonstrated a high likelihood of union for the femoral neck fractures and a low risk of malunion. Comminution and initial displacement of the proximal femoral fracture may still lead to a small incidence of malunion or nonunion, and open comminuted femoral shaft fractures still may progress to nonunion despite appropriate surgical management.
LEVEL OF EVIDENCE
Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
背景
虽然不常见，但股骨近端骨折合并同侧股骨干骨折会带来棘手的治疗难题。已采用多种手术方式，效果各异。
问题/目的：我们研究了使用髋螺钉和扩髓逆行髓内钉治疗这种复合型骨折的术后对线情况（畸形愈合）、骨不连及并发症。
方法
2002年5月至2011年10月期间，三家一级创伤中心共治疗了95例股骨近端骨折合并股骨干骨折的患者；均采用髋螺钉固定（空心螺钉或滑动髋螺钉）及逆行扩髓髓内钉治疗。对这些患者的病历进行回顾性分析，以评估对线情况、畸形愈合、骨不连及并发症。95例接受髋螺钉和逆行髓内钉治疗的患者中，92例（97%）获得随访。40例采用滑动髋螺钉治疗，52例采用空心螺钉治疗。
结果
本系列中有5例近端畸形愈合（5%）。初次手术后，股骨颈骨折的愈合率为98%（92例中的90例），股骨干骨折的愈合率为91.3%（92例中的84例）。空心螺钉固定后，有2例粉碎性股骨颈骨折发生骨不连。比较空心螺钉和滑动髋螺钉时，股骨颈的愈合情况或对线情况无差异。4例开放性粉碎性股骨干骨折发生骨不连，需要二次手术以实现愈合，1例患者出现有症状的股骨头缺血性坏死。
结论
采用髋螺钉固定和扩髓逆行髓内钉治疗同侧股骨近端颈和骨干骨折，股骨颈骨折愈合可能性高，畸形愈合风险低。股骨近端骨折的粉碎和初始移位仍可能导致小概率的畸形愈合或骨不连，尽管手术处理得当，开放性粉碎性股骨干骨折仍可能进展为骨不连。
证据水平
四级，治疗性研究。有关证据水平的完整描述，请参阅《作者须知》。
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