带锁髓内钉治疗股骨干骨折合并股骨颈及转子间骨折或转子下粉碎骨折

目的应用带锁髓内钉治疗股骨干骨折合并同侧股骨颈骨折及转子间骨折或转子下粉碎骨折。方法在1996年7月～1998年11月收治的16例复杂股骨骨折中,股骨干骨折合并同侧股骨颈骨折3例,合并转手间骨折4例,转子下粉碎骨折9例。其中10例应用国产加长型Gamma钉,6例使用Russell－Taylor股骨重建钉固定。结果所有病例随访6～22个月,平均11个月。除1例股骨干骨折合并同侧股骨颈骨折患者术后7个月出现股骨头坏死外,其余15例骨折均愈合,平均愈合时间5．5个月,患肢关节功能优良。经此方法治疗后可早期活动关节及功能锻炼、手术创伤小、切口小、固定可靠、骨折愈合率高。结论　　对股骨干骨折合并同侧股骨颈骨折及转手间骨折或转子下粉碎骨折的治疗,带锁髓内钉具有明显优势。     

股骨干顺行髓内钉固定后同侧股骨颈骨折的治疗

目的：探讨股骨干骨折行顺行髓内钉固定后发现同侧股骨颈骨折的治疗方法。方法：回顾性分析2000年1月至2010年1月股骨干骨折行顺行髓内钉固定后术中或术后发现同侧股骨颈骨折的患者12例,全部以2枚螺钉分别自髓内钉前后方固定股骨颈骨折,定期随访,评估骨折愈合及功能恢复情况。结果：术后随访10—36个月,平均16．5个月。股骨颈骨折平均愈合时间3．6个月,股骨干骨折平均愈合时间5．4个月,无股骨头坏死发生。按Harris评分标准髋关节功能：优7例,良3例,可2例。结论：股骨干骨折顺行髓内钉固定后发现同侧股骨颈骨折,以2枚螺钉分别自髓内钉前后方固定股骨颈骨折方法可行,固定可靠,手术创伤小,骨折愈合率高。     

交锁髓内钉治疗股骨干粉碎性骨折

目的探讨使用交锁髓内钉治疗股骨干粉碎性骨折的手术方式选择、疗效。方法对1998年1月～2002年10月使用交锁髓内钉治疗67例(76肢)股骨干粉碎性骨折的疗效进行回顾性分析。手术采用闭合、小切口或有限切开复位，用三维瞄准器锁定骨折远近端。结果平均随访14．1个月，肢体、关节功能恢复优良率92．5％(62／67)，一期骨折愈合率90．8％(69／76)。平均骨临床愈合时问6．7个月。2例软组织感染，感染率2．6％，2例髓内钉断裂。结论交锁髓内钉治疗股骨干粉碎性骨折应常规静力固定，不剥离或少剥离骨膜．不强求解剖复位，尽量闭合复位、有限扩髓，是目前治疗股骨干粉碎性或多节段骨折的有效方法。     

Treatment of ipsilateral femoral neck and shaft fractures

Objective：To investigate the clinical characteristics, treatment options and causes of misdiagnosis of ipsilateral femoral neck and shaft fractures.
Methods： Among 20 patients with ipsilateral femoral neck and shaft fractures, 19 were treated operatively and 1 was treated conservatively. Sixteen cases of femoral shaft fractures were treated by open reduction and internal fixation with compressive plate, and 2 cases were treated with interlocking intramedullary nailing. Eighteen femoral neck fractures were treated with cannulated screws. Another patient was treated with proximal femoral nail to fix both the neck and shaft. Delayed diagnosis for femoral neck frac-tures occurred in 2 cases preoperatively. Results： A total of 19 patients were followed up. The follow up period ranged from 5 to 48 months with an average of 15 months. All the fractures were healed.
Conclusion： For case of femoral shaft fracture caused by high energy injury, an AP pelvic film should be routinely taken. Once the femoral neck fracture is recognized, operative reduction and fixation should be performed in time. Femoral neck and shaft fractures should be fixed separately.     

Treatment of femoral shaft fractures with Grosse-Kempf intramedullary nail

Ninety consecutive femoral shaft fractures in 87 patients treated by reamed Grosse-Kempf intramedullary nailing were reviewed. The median observation time was 45 months. The functional results were excellent or good in 82% of the fractures, fair in 16%, and poor in 2%. Four non-unions and two superficial infections were observed. Leg shortening of more than 2 cm was recorded in 2 patients. Rotatory malalignment exceeded more than 15° in 2 patients. We conclude that reamed Grosse-Kempf intramedullary nailing is an excellent treatment for femoral shaft fractures. Although this study represents the first period during which we used the nail, the number of complications was acceptable. Received: July 8, 1999 / Accepted: December 6, 1999     

交锁髓内钉治疗股骨干合并股骨颈骨折

我科自 2 0 0 1年 9月采用Ⅱ型交锁髓内钉 (重建钉 )治疗此类骨折 16例取得了满意的治疗效果。现将发病原因及结果报告如下。1　临床资料本组 16例中男 12例 ,女 4例 ;年龄 2 1～ 6 3岁 ,平均 2 7岁。左侧 10侧 ,右侧 6例。其中 3例系股骨干骨折Ⅰ型交锁髓内钉内固定术后并发 ,其余 13例系交通事故所致。近端骨折均为闭合性。其中股骨颈囊内骨折 11例 ,股骨颈基底部骨折 5例。股骨干骨折中 ,长斜形 5例 ,横断骨折 4例 ,螺旋形骨折 3例 ,粉碎性骨折 4例。合并损伤 :3例合并肋骨骨折 ,肺挫伤 ,1例脾破裂 ,2例骨盆骨折 ,1例同侧胫腓骨骨折 ,1例…     

交锁髓内钉治疗股骨干骨折(附45例报告)

目的: 探讨使用交锁髓内钉治疗股骨干骨折的应用、手术方式选择及疗效。方法: 对使用交锁髓内钉治疗 45例 (48肢) 股骨干骨折的疗效进行回顾性分析。手术采用闭合、小切口或有限切开复位, 用三维瞄准器锁定骨折远、近端。结果: 48例患者平均随访 13. 5个月, 肢体、关节功能恢复优良率 91. 1%(41 /45), 一期骨折愈合率 89. 6% (43 /48 )。平均骨临床愈合时间 6. 8个月。感染率 2. 1% ( 1 /45 )。1例髓内钉断裂。结论: 交锁髓内钉是目前治疗股骨干骨折的首选方法, 术中应常规静力固定, 不剥离或少剥离骨膜, 不强求解剖复位, 尽量闭合复位、有限扩髓。     

带锁髓内钉治疗股骨干骨折

我院自1998年1月-2001年5月,应用带锁髓内钉治疗各种类型股骨干骨折41例,取得满意疗效. 　　1 临床资料 　　本组41例(42个股骨)中男32例,女9例;右侧25个股骨,左侧17个股骨.平均年龄37岁(17～65岁).均为闭合性骨折.骨折类型(AO分型):A型15侧,B型22侧,C型5侧.致伤原因:交通事故伤31例,摔伤6例,砸伤4例,合并胫腓骨骨折7例,踝部骨折5例,骨盆骨折3例,肋骨骨折3例,5例合并休克,4例有颅脑外伤.……     

A comparative study of ipsilateral intertrochanteric and femoral shaft fractures treated with long proximal femoral nail antirotation or plate combinations

Objective: To compare the results of long proximal femoral nail antirotation (PFNA‐long) and plate combinations in the treatment of ipsilateral intertrochanteric and femoral shaft fractures. Methods: Between March 2004 and April 2009, 23 patients with ipsilateral intertrochanteric and femoral shaft fractures were treated with PFNA‐long or plate combinations. The patients were divided into two groups. Group I contained 13 patients who were treated with dynamic hip screws (DHS) combined with compression plate fixation. The 10 patients in Group II were treated with PFNA‐long. Results: The average follow‐up was 17.8 and 16.8 months for Groups I and II, respectively. The average union time for intertrochanteric fractures was 17.4 and 16.6 weeks in Groups I and II, respectively, and for femoral shaft fracture 22.2 and 21.5 weeks, respectively. There were nine good, two fair, and two poor functional results in Group I, and eight good, one fair, and one poor in Group II. There was nonunion of two femoral shaft fractures in Group I and one in Group II. There were no significant differences between the two groups in functional outcomes or major complications. Conclusion: Both treatment methods achieve satisfactory functional outcomes in patients with ipsilateral intertrochanteric and femoral shaft fractures. PFNA‐long is the better choice for the treatment of complex fractures, having the advantages of minimal exposure, reduced perioperative blood loss, and achievement of biological fixation of both fractures with a single implant.     

股骨干骨折髓内钉远端徒手锁钉技术及应用解剖学研究

目的:探讨股骨干骨折髓内钉固定时远端徒手锁钉的可行性。方法:选取成人不成对股骨防腐标本22根,对12根标本远端锁钉横截面的周径、外侧边边长及外侧上下角进行测量。选最大截面运用平面几何与三角函数来计算探针通过截面外侧边上探测孔的最大摆动角并确定探测孔的最佳定位点。用直径1mm的克氏针经过直径4mm的探测孔来探测直径为9mm的髓内钉,并通过10根股骨干骨折模型及15例临床股骨干骨折病例对徒手锁钉法加以验证。结果:股骨干远端锁钉横截面即股骨远端骨骺线上3cm处的横截面,其外周径为(153.00±7.45)mm,外侧边长为(36.30±2.65)mm,外上角为102.42±5.85°,外下角为81.00±3.25°,外侧边髓腔厚度(1.96±0.04)mm。在最大的横截面处当探查孔直径为4mm时,在外侧两边角区存在盲区(即髓内钉位于其间但通过探查孔的探针不能探到的区间)。但当髓内钉通过约10cm的髓腔狭窄段时,髓内钉不会到达盲区。探针向上、向下的最大摆动角均为44°,当探查孔定位于外侧边中点时,如髓内钉通过的10cm的髓腔狭窄段,骨折复位满意时是可以被探针探及的。应用此法在10根标本及14例利用定位器远端锁钉失败的临床病例中获得成功。结论:通过股骨外侧4mm的探查孔用直径1mm的细克氏针滑移来寻找髓内钉徒手锁钉的方法是可行的。     

重建钉治疗股骨干合并同侧髋部骨折的临床观察

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WinquistI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例,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2cm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。     

Cephalomedullary interlocked nail for ipsilateral hip and femoral shaft fractures

A retrospective study of the management of 23 cases of ipsilateral hip and femoral shaft fractures, between January 1998 and December 2001, is presented. All except two cases were managed by a single implant, i.e. reconstruction nail. There was delayed diagnosis of femoral neck fracture in two cases where the "miss a nail" technique was used for fixation of the femoral neck fracture. All patients managed by reconstruction nail were simultaneously operated on for both fractures and operative treatment was executed as early as the general condition of the patient permitted. Delay in treatment was generally because of the associated injuries (head, chest or abdominal). There were 22 males and 1 female patient with an average age of 34.5 years. Average follow-up was 30.9 months. There was one case of non-union of the femoral neck fracture, one case of avascular necrosis and one femoral neck fracture united in varus. There were four cases of non-union and six cases of delayed union of femoral shaft fractures. Mean time for union of the femoral neck fracture was 15 weeks and for the shaft fracture was 22 weeks. In this series femoral shaft fracture determined the total union period. Complications involving the femoral shaft fracture were more common than those related to femoral neck fractures. Shaft complications were more manageable with or without secondary procedures as compared to femoral neck complications, which usually require more extensive procedures. This stresses the need to realise the significance and seriousness of both components of this complex injury, in evaluation, management and post-operative care. We conclude that, though technically demanding, reconstruction nail is an acceptable alternative for management of concomitant fractures of the femoral neck and shaft with acceptable rates of complications and good results.     

股骨粗隆部取骨髓内钉固定治疗新鲜股骨干 粉碎性骨折

目的:评价应用股骨粗隆部取骨髓内钉固定治疗新鲜股骨干粉碎性骨折的疗效。方法:2009年1月至2010年1月,采用股骨粗隆部取骨髓内钉固定治疗新鲜股骨干粉碎性骨折50例,男35例,女15例;年龄28～50岁,平均38.4岁。根据AO骨折分类原则,其中B1型15例,B2型20例,B3型8例,C1型7例。结果:50例均获得随访,随访12～24个月,平均14.4个月。所有病例均于4～6个月内获得骨性愈合,平均愈合时间5.6个月。膝关节活动正常,无感染、血管神经损伤等并发症。根据Merchan膝关节功能评分标准,优25例,良20例,可3例,差2例。结论:用髓内钉固定治疗新鲜股骨干粉碎性骨折的同时,于股骨粗隆部取骨作为植骨材料,具有损伤小、失血少、骨折愈合率高、功能恢复好的优点,是新鲜粉碎性股骨干骨折的理想疗法。     

器械辅助复位联合带锁髓内钉内固定术治疗复杂股骨干多段骨折

目的:探讨复杂股骨干多段骨折实施微创小切口、器械辅助复位联合带锁髓内钉固定术的手术疗效。方法:2013年1月至2016年1月采用器械辅助复位联合带锁髓内钉内固定术治疗32例股骨干多段骨折患者,男22例,女10例;年龄17~68岁,平均45岁;受伤距手术时间5~10 d,平均7 d;入院后视情况常规行胫骨结节或股骨髁上骨牵引术,对患者全身情况进行评估,术中记录手术时间、术中出血量。依据Thorsen股骨骨折术后形态评估标准及Hohl膝关节功能评价标准对术后疗效进行评价,观察术后骨折愈合、并发症发生及患肢功能恢复情况。结果:所有病例获得随访,时间6~24个月,平均12个月;手术时间48~76 min,平均67 min;术中出血量150~400 ml,平均220 ml;手术切口均达甲级愈合,骨折均达临床愈合标准,骨折愈合时间4.2~10.8个月,平均5.7个月;无骨不连、切口感染及内固定断裂、失效等并发症发生;依据Thorsen股骨骨折术后形态评估标准:优28例,良3例,可1例;依据Hohl膝关节功能评价标准:优30例,良2例。结论:器械辅助复位联合带锁髓内钉内固定术治疗复杂股骨干多段骨折,具有创伤小、固定可靠、恢复快、术后可早期行功能锻炼等优点,符合BO固定原则,是治疗股骨多段骨折的一种有效方法。     

闭合复位带锁髓内钉治疗股骨干骨折

目的：探讨闭合复位带锁髓内钉治疗股骨干骨折的临床疗效.方法：自2006年3月至2011年12月采用闭合复位带锁髓内钉治疗103例股骨干骨折患者,其中男76例,女27例;年龄19～55岁,平均36岁.按照AO分型：A型64例,B型27例,C型12例;开放性骨折13例（Gustilo Ⅰ型5例,Ⅱ型8例）.观察术后患者骨折愈合时间,并采用膝关节HSS评分标准对术后1年膝关节功能恢复情况进行评价.结果：术中发生股骨颈骨折1例,股骨近端骨折1例,均于术中更换重建钉固定,术后骨折愈合.术中发生腓总神经损伤1例,营养神经治疗4个月后恢复.103例患者全部获得随访,时间12～28个月,平均22个月.全部患者获得骨性愈合,愈合时间3～9个月,平均5个月.髋关节功能全部恢复正常,术后1年膝关节行HSS评分平均90.89±5.06.结论：注重手术操作,力求闭合复位,减少并发症,带锁髓内钉是治疗股骨干骨折的首选方法.     

股骨干骨折合并同侧股骨颈骨折手术方法的选择及疗效分析

目的 探讨股骨干骨折合并同侧股骨颈骨折的手术方法及疗效.方法 2004年11月至2009年11月共收治42例股骨干骨折合并同侧股骨颈骨折患者,男37例,女5例;年龄21～84岁,平均59.2岁.股骨干骨折部位:近段18例,中段17例,远段7例.股骨颈骨折按Garden分型:Ⅰ型5例,Ⅱ型10例,Ⅲ型21例,Ⅳ型6例.本组患者均于入院后3 d内确诊,无误诊及漏诊.其中20例患者行人工关节置换治疗,为关节置换组;22例患者行空心钉、髓内钉或钢板内固定,为内固定组.回顾性分析并比较两组患者的疗效.结果 42例患者术后获1～3年(平均2年)随访.股骨干骨折愈合时间为14～24周,平均18周;股骨颈骨折愈合时间为12～20周,平均16周.两组患者平均住院时间、手术时间、术中出血量、术后下床活动时间差异均有统计学意义(P<0.05).关节置换组术后髋关节功能优良率为95.0%,内固定组术后髋关节功能优良率为72.7%,差异有统计学意义(x2=9.251,P=0.000).两组未发生并发症的患者术后1、2、3年Merchan评分比较差异均无统计学意义(P>0.05).结论股骨干骨折合并同侧股骨颈骨折的治疗应根据患者的体质、年龄、股骨干骨折的部位及股骨颈骨折的移位程度来确定.对于年龄较大、体质较差的患者,行人工股骨头置换术是一种较好的选择.

Abstract：

Objective To investigate clinical features,operative treatments and outcomes of ipsilateral fractures of femoral shaft and neck. Methods Forty-two cases of ipsilateral fractures of femoral neck and shaft were treated from November,2004 to November,2009 in our institution.They were 37 males and 5 females.Their ages ranged from 21 to 84 years,with an average of 59.2 years.The fracture involved 18upper shafts,17 middle shafts and 7 lower shafts.By Garden classification,there were 5 cases of type Ⅰ,10cases of type Ⅱ,21 cases of type Ⅲ,and 6 cases of type Ⅳ neck fractures.All cases were diagnosed in 3days after admission;there were no misdiagnosis or missed diagnosis.Twenty patients were treated by artificialjoint replacement(replacement group),while 22 patients by fixation with cannulated nails,intramedullary nails,or plate(fixation group).Outcomes were compared between the 2 groups. Results All cases were followed up for 1 to 3 years,with an average of 2 years.Femoral neck fractures united between 12 to 20weeks,with an average of 16 weeks;femoral shaft fractures united between 14 to 24 weeks,with an average of 18 weeks.There were significant differences between the 2 groups in average length of hospital stay,ambulation time,blood loss,postoperative activities and good to excellent rate of postoperative joint function(P<0.05).There were no significant differences between the 2 groups in the Merchan scores 1,2,and 3 years after operation for complication-free patients(P>0.05). Conclusion Surgical treatment of ipsilateral fractures of femoral neck and shaft depends on position of the shaft fracture,displacement of the neck fracture,physical constitution and age of the patient to be treated.     

股骨近端带锁髓内钉治疗股骨转子部骨折

股骨转子部骨折是临床常见的骨折,好发于老年人,目前治疗方法很多,我院2000年10月-2004年12月,用股骨近端髓内针（PFN）治疗股骨转子部骨折32例,取得良好疗效。1临床资料本组患者32例,男21例,女11例;年龄47⁷3岁,平均60岁;受伤距手术时间2¹7d,平均8d。按AO分类A1型7例,A2型17例,A3型8例。其中1例合并胫腓骨骨折,2例合并脑挫伤,1例合并肋骨骨折并血气胸。手术使用骨科牵引床,C形臂X线机下复位锁定,手术时间约60²10min。2方法2·1治疗方法采用硬膜外麻醉,置骨科牵引床上,将C形臂放于髋部以便取得良好的X线透视效果。自大转子顶点向近端行切口并从顶点插     

股骨近端带锁髓内钉治疗股骨转子部骨折

股骨转子部骨折是临床常见的骨折,好发于老年人,目前治疗方法很多,我院2000年10月-2004年12月,用股骨近端髓内针(PFN)治疗股骨转子部骨折32例,取得良好疗效。1临床资料本组患者32例,男21例,女11例;年龄47~73岁,平均60岁;受伤距手术时间2~17d,平均8d。按AO分类A1型7例,A2型17例,     

Orthofix交锁髓内钉治疗股骨干骨折骨不连

交锁髓内钉可以非常有效地治疗股骨干骨折骨不连 ,具有操作简单、固定牢靠、骨折愈合率高、并发症少等优点。我院自 1999年 5月开始使用Ｏｒｔｈｏｆｉｘ交锁髓内钉治疗股骨干骨折骨不连 198例 ,疗效满意。1　临床资料本组 198例患者 ,都是由于内固定失效造成骨不连。其中男 15 1例 ,女 4 7例 ;年龄最大 5 8岁 ,最小 2 1岁 ,平均 4 1岁。内固定折断情况 :钢板 10 1例 ,Ⅴ型针 13例 ,梅花针 6 4例 ,钢丝 2 0例。2　手术方法麻醉后患者仰卧位 ,视骨折端位置考虑使用无菌止血带。同侧髂骨开窗取骨块备用。为减少病人的损伤 ,按原手术切口进入骨…     

股骨干骨折交锁髓内针内固定术后局部出现骨化性肌炎5例

股骨干骨折交锁髓内针固定术后局部出现骨化性肌炎(Myositis ossificans)鲜有报道,我科自2003年1月-2005年9月共发生5例,报告如下。1临床资料切开复位交锁髓内针内固定治疗股骨干骨折患者61例,术后均放置引流管(24～72h拔管)。术后发生局部骨化性肌炎的5例,均为男性,年龄22～46