重建钉治疗股骨干合并同侧髋部骨折的临床观察

摘要

Objective: To evaluate the curative effect and surgical skills of reconstruction intramedullary nailing for ipsilateral fractures of shaft of femur and hip. Methods: Fifteen patients with ipsilateral femoral shaft and hip fractures from June 2002 to June 2008 were treated with reconstruction intramedullary nails. All of them were male with an average age of 45 years (range,34-85 years). According to the Winquist-Hansen classification,there were 2 type Ⅰ ,6 type Ⅱ ,2 type Ⅲ ,and 2 type Ⅳshaft fractures. Hip fractures consisted of 7 intertrochanteric and 8(53.3％) neck fractures. According to Garden＇s classification, 1 femoral neck fracture was type Ⅰ ,3 were type Ⅱ ,2 were type Ⅲ and 2 were typeⅣ/. Results:All of the patients were followed up for an average of 30.9 months (range, 12 to 55 months). Due to other combined severe injuries,operations were delayed for 1-14 days(average is 5 days). Delayed union of femoral shaft occurred in 1 case; nonunion of femoral shaft occurred in 2 cases. Nonunion of femoral neck occurred in 1 and coxa vara occurred in 1. Hip fractures healed in 14 (93.3％)patients,and shaft fractures healed in 13 (86.7％)patients. The average union time was 4 months (range,2-6 months) for the hip fractures and 5.5 months (range,4-9 months) for the shaft fractures. No femoral head osteonecrosis ,wound infection or shortening more than 2 cm occurred. Functional results using Friedman-Wyman criteria were good in 13 cases,fair in 1 ease,and poor in 1 case. Conclusion: Reconstruction intramedullary nails can provide biological fixation of both fractures with fewer complications,and is an effective device to treat this kind of combined fractures.%目的:评价股骨重建钉治疗股骨干合并同侧髋部骨折的临床疗效及手术要点.方法:自2002年6月至2008年6月采用重建钉治疗15例股骨干合并同侧髋部骨折患者,全部为男性,年龄34～85岁,平均45岁.股骨干骨折Winquist Ⅰ型2例,Ⅱ型6例,Ⅲ型2例,Ⅳ型2例,3例多段骨折.髋部骨折包括粗隆间骨折7例.股骨颈骨折8例(根据Garden分型,Ⅰ型1倒,Ⅱ型3例,Ⅲ型2例,Ⅳ型2例).结果:15例患者均获随访,时间12～55个月,平均30.9个月.股骨颈骨折不愈合1例,内翻畸形1例;14例2-6个月获得髋部骨折愈合,平均4个月.股骨干骨折延迟愈合1例(9个月时愈合),不愈合2例;13例4～9个月获得股骨干愈合,平均5.5个月.无感染、股骨头坏死及超过2 cm的下肢短缩.Friedman-Wyman系统疗效评价:优良13例,一般1例,差1例.结论:股骨重建钉对于股骨干合并同侧髋部骨折固定可靠,并发症少.是一种有效的固定方式.