股骨干骨折合并同侧隐性股骨颈骨折的诊治分析

目的探讨对股骨干骨折合并同侧隐性股骨颈骨折的诊治方法。方法1998年3月至2003年10月我院共收治股骨干合并同侧隐性股骨颈骨折9例。回顾性分析这9例患者的临床资料。9例患者术前CT诊断隐性股骨颈骨折3例,术中诊断5例,术后CT发现合并股骨颈骨折1例。其中5例采用股骨重建髓内针同时固定股骨干和股骨颈骨折;3例患者股骨干采用逆行髓内针固定而股骨颈采用空心钉固定;另1例在顺行完成股骨干固定后用2枚空心钉固定股骨颈。结果所有患者均获得随访,随访时间6～36个月,平均20个月。全部股骨干骨折均在术后6个月内愈合,股骨颈骨折在3个月内愈合。结论股骨干骨折合并同侧隐性股骨颈骨折早期漏诊率高,临床医生通过对患者的受伤机制分析,对高能量损伤患者应考虑隐性股骨颈骨折的可能,术前可用CT获得诊断,行股骨干骨折带锁髓内针时术中和术后密切注意股骨颈骨折是否存在,从而减少股骨颈骨折的漏诊率。采用髓内针固定可获得满意疗效。     

同侧股骨干并股骨颈骨折7例

同侧股骨干合并股骨颈骨折临床较少见,其发生率为5%～6%^[1]。2005年至2007年12月收治股骨干骨折135例,其中合并同侧股骨颈骨折7例,占5%,现将其治疗体会进行分析总结如下。     

Management of neglected femoral neck fracture in above knee amputated limb: A case report

The treatment of an above knee amputee who has sustained a fracture of the femoral neck is a challenging situation for both the orthopedic surgeon and the rehabilitation team. These fractures may be managed acutely either by reduction and internal fixation or by endoprosthetic replacement based on the same criteria as in any other patient with otherwise intact limbs. We present a neglected case treated successfully with valgus osteotomy. We conclude that these fractures should be treated with the same urgency and expertise as similar fractures in non-amputees as long-term survival and good quality of life can be expected.     

带旋髂深血管蒂髂骨瓣植骨治疗青壮年陈旧性股骨颈骨折

目的 应用带旋髂深血管蒂髂骨瓣植骨治疗青壮年陈旧性股骨颈骨折，探讨其早中期随访结果。方法 1997年1月至2003年12月，收治31例陈旧性股骨颈骨折患者，其中有完整随访资料者26例。男19例，女7例；年龄15-38岁，平均25岁。致伤原因：交通伤17例，高处坠落伤9例。Garden骨折分型：Ⅲ型11例，Ⅳ型15例。保守治疗骨折不愈合11例，术后骨折不愈合15例（闭合复位骨圆针固定6例、切开复位螺纹钉或骨圆针固定9例）。受伤时间6-17个月，平均8．5个月。多数患者存在不同程度的肢体短缩及髋关节活动功能受限。X线片显示股骨颈骨折移位17例．股骨颈不同程度吸收9例。手术采用切开复位。带旋髂深血管蒂髂骨瓣植骨及螺纹钉、空心螺钉或骨圆针固定。术后6-8个月开始部分负重．术后11个月开始完全负重。结果 26例随访28-69个月，平均41个月。骨折全部愈合，愈合时间11-15个月，平均12．5个月。随访期间2例发生股骨头坏死。5例患肢短缩超过3cm的患者术后无进一步短缩。Harris髋关节功能评分平均为82．8分。结论 带旋髂深血管蒂髂骨瓣植骨可以改善骨折端的血运，促进青壮年陈旧性股骨颈骨折的愈合。     

Bilateral combined femoral neck and acetabular fractures due to cerebro-vascular ischaemic induced convulsion

Summary Skeletal fractures and joint dislocations secondary to sustained myoclonic activity occur infrequently. Fractures at or around the hips resulting from seizures are extremely rare. Causes have included: 1. electroconvulsive therapy [1], 2. idiopathic epilepsy [2], 3. hyponatraemia [3, 4], 4. eclampsia [5], 5. alcohol withdrawal [6], 6. Renal failure [7], and 7. prolonged, sustained myoclonus [8]. We report a unique case with an unusual skeletal injury pattern secondary to an unusual cause.     

Simultaneous bilateral femoral neck fractures after electrical shock injury: a case report

Simultaneous bilateral fractures of the femoral necks are rare injuries,especially when there is no underlying pathological condition.We report a 20-year-old man who sustained bilateral femoral neck fr...     

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.     

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.     

股骨干骨折合并同侧股骨颈骨折的手术治疗

目的探讨股骨干骨折合并同侧股骨颈骨折的手术方法和疗效.方法回顾性分析自1996年1月至2002年12月应用手术治疗资料完整的26例股骨干骨折合并同侧股骨颈骨折患者,男22例,女4例;年龄17～50岁,平均28岁.受伤原因：交通伤17例,高处坠落伤9例.入院后即刻确诊股骨颈骨折16例;延迟诊断10例,延迟时间为3～75 d,平均13.1d.全部病例均采用切开复位内固定,其中股骨干骨折采用动力加压钢板内固定13例,顺行髓内钉固定2例,逆行髓内钉固定5例,该20例患者合并的股骨颈骨折采用空心钉固定;股骨干及股骨颈骨折同时应用重建髓内钉固定4例,动力髋螺钉（DHS）固定2例.结果术后随访3～9年,平均4.4年.25例股骨干骨折于术后16～32周骨折愈合,平均20周;1例在术后18个月骨折仍未愈合,经再次手术内固定并植骨后24周愈合.25例股骨颈骨折于术后12～28周骨折愈合,平均16周;1例股骨颈骨折10个月不愈合,行全髋关节置换.术后并发症包括伤口感染1例,内固定断裂1例,股骨头缺血性坏死1例,膝关节活动受限3例.结论股骨干合并同侧股骨颈骨折相对较少,漏诊率较高（38.5%）且治疗复杂.治疗应根据股骨干骨折的部位和股骨颈骨折的移位程度来确定内固定方式.     

老年性股骨颈骨折178例分析

股骨颈骨折是一种治疗较困难的损伤。现将我院近20年来收治的股骨颈骨折178例治疗结果分析如下。1 临床资料 178例中男113例,女65例;年龄54～87岁,平均64.8岁。骨折类型:头下型71例,头颈型51例,经颈型37例,基底型19例。骨折移位:GardenⅠ型4例,Ⅱ型37例,Ⅲ型86例,Ⅳ型51例。接受非手术治疗43例,手术治疗135例,其中三翼钉固定术36例,多枚斯氏针固定4例,3根加压折断螺纹钉固定术45例,3根空心加压螺纹钉固定术15例,人工股骨头置换术35例。2 结果 股骨颈骨折愈合较慢,本组病例观察愈合时间12～48周,平均26周,因此判定愈合与否不得少于1     

偏心距重建对股骨颈骨折关节置换术后恢复的影响

目的 探讨股骨颈骨折行人工关节置换术重建股骨偏心距(FO)对患者髋关节功能Harris评分及髋关节活动度的影响.方法 2004年2月至2005年10月对47例单侧股骨颈骨折行人工髋关节置换术的患者进行随访.随访时摄X线片测量,对比患侧与健侧FO.分析术后FO与患肢髋关节Harris评分及髋关节活动范围的相关性,对全髋关节置换术和人工双极头置换术的FO重建率进行χ2检验.结果 FO绝对值大小与患侧髋关节功能Harris评分高低尢相关关系(r=0.23,P=0.1 18),是否进行FO重建在髋关节功能Harris评分方面差异有统计学意义(t=7.25,P＜0.001)髋关节外展范围与FO存在明显正相关性(r=0.80,P＜0.001),全髋置换术及人工双极头置换术的FO重建率差异无统计学意义(χ2=0.13,P＞0.05).结论 股骨颈骨折人工髋关节置换术中重建FO有助于术后髋关节功能的恢复.FO的重建能影响髋关节的外展范围,但与术式选择(全髋置换术或人工双极头置换术)无关.     

同侧股骨干股骨颈骨折

目的探讨同侧股骨干、股骨颈骨折的临床特点及诊断要点。方法对1995年5月～1999年5月间治疗的初诊时未诊断出股骨颈骨折的7例同侧股骨干合并股骨颈骨折的骨折类型、膝关节合并损伤、股骨颈骨折诊断时间、治疗方法、随访结果等进行了回顾性研究。结果7例股骨干骨折均发生于中1/3,股骨颈骨折均为基底型,2例合并膝关节其他骨折,股骨颈骨折诊断延误时间1～75d,除1例保守治疗外,其余6例股骨干骨折及5例股骨颈骨折均行手术治疗,另1例股骨颈骨折确诊时已近临床愈合。平均随访时间15.6个月,7例股骨颈及股骨干骨折均获得愈合,2例股骨颈骨折畸形愈合。所有患者随诊时均未发现股骨头有缺血性坏死的表现。结论对高能损伤造成的股骨干骨折患者应常规拍摄骨盆前后位X线片。对髋关节X线片表现阴性,但股骨干骨折内固定之后仍主诉髋关节疼痛的患者应进行动态检查。一旦发现合并股骨颈骨折应争取早期复位内固定,手术治疗效果优于非手术治疗。     

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。     

Bilateral femoral neck stress fractures following total knee arthroplasty: a case report and review of literature

Stress fracture of the femoral neck following total knee arthroplasty (TKA) is an uncommon complication with only 20 cases having been described in English literature so far. Stress fractures of femoral neck occurring simultaneously on both sides following a bilateral total knee replacement is an exceptional occurrence, which to the best of our knowledge, has not been described previously. We describe a patient suffering from osteoarthritis of both knees, who was treated with bilateral total knee arthroplasty simultaneously. He developed spontaneous fractures of femoral neck on both sides 9 months following the total knee replacement in the absence of any known risk factors for stress fractures. He was treated with bipolar hemi replacement arthroplasty for displaced fracture on one side and closed reduction/internal fixation on the undisplaced side. A high index of suspicion is needed to diagnose this unusual complication of total knee arthroplasty before the fracture displaces necessitating a prosthetic replacement.     

Valgus osteotomy in delayed presentation of femoral neck fractures using fixed angle simple dynamic hip screw and plate

Purpose

Reduction and fixation in femoral neck fracture in young patients have a problem of nonunion requiring additional procedure like valgus osteotomy but fixation devices are technically difficult for inexperienced surgeons. We aims to assess the results of valgus osteotomy in femoral neck fracture in our setup.

两种手术方法治疗股骨干合并同侧股骨颈骨折的疗效比较

目的 比较股骨重建钉与逆行髓内钉加空心钉治疗股骨于合并同侧股骨颈骨折的疗效,探讨各自的手术适应证.方法 回顾性分析2001年1月至2010年5月收治的21例股骨干合并同侧股骨颈骨折患者资料,采用股骨重建钉固定10例(股骨重建钉组),逆行髓内钉加空心钉固定11例(逆行髓内钉加空心钉组).两组患者术前一般资料差异均无统计学意义(P＞0.05),具有可比性.术后1、3、6、9、12个月及以后每年随访1次,通过临床和影像学评估骨折愈合情况和并发症的发生情况.结果 21例患者术后获12 ～48个月(平均27.1个月)随访.两组患者在手术时间、术中出血量、术后引流量、住院时间、股骨干骨折愈合时间、股骨颈骨折愈合时间及Friedman-Wyman功能评定结果等方面差异均无统计学意义(P＞0.05).股骨重建钉组住院费用高于逆行髓内钉加空心钉组,差异有统计学意义(t=16.710,P=0.016).两组股骨干骨折愈合率(9/10 vs.10/11)、股骨颈骨折愈合率(9/10 vs.11/11)差异均无统计学意义(P＞0.05).股骨重建钉组4例发生并发症,逆行髓内钉组7例发生并发症.结论 股骨干合并同侧股骨颈骨折的治疗应采取个体化原则.股骨重建钉更适用于股骨颈基底部骨折合并狭部及狭部以近的股骨干骨折;对于头下型、难复位的股骨颈骨折合并同侧股骨干远端骨折或需要同时处理的膝关节内损伤、关节周围骨折的患者,逆行髓内钉加空心钉更为理想.     

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。     

重建钉治疗股骨干合并同侧股骨颈骨折

目的:评价重建钉治疗同侧股骨干合并股骨颈骨折的临床疗效及手术方法.方法:自2007年1月至2013年1月共采用股骨重建钉固定手术治疗同侧股骨干合并股骨颈骨折患者13例,其中男11例,女2例;年龄25~53岁,平均38.9岁.其中股骨颈骨折依据骨折部位分为基底型10例,经颈型3例;依据Garden分型:Ⅱ型10例,Ⅲ型2例,Ⅳ型1例.股骨干骨折依据Winquist分型:Ⅰ型5例,Ⅱ型4例,Ⅲ型3例,Ⅳ型1例,骨折部位均为股骨干中上3/4.记录患者并发症及术后患肢功能恢复情况.结果:11例患者得到随访,随访时间12~36个月,平均23.45个月.受伤至手术时间平均5.9 d.1例患者出现股骨颈骨折畸形愈合,2例患者出现股骨干骨折不愈合,无感染、股骨头坏死及股骨干畸形愈合患者.依据Friedman-Wyman疗效评价标准,优良8例,一般2例,差1例.结论:股骨重建钉是股骨干合并同侧股骨颈骨折治疗中的一种良好内固定方式,具有创伤小、并发症少等优势.     

股骨颈嵌插型骨折空间移位程度的三维重建研究

  目的 测量股骨颈嵌插型骨折股骨头的空间移位参数, 以重新认识股骨颈嵌插型骨折。 方法收集50 例股骨颈嵌插型骨折患者双侧股骨近端的多层螺旋CT扫描的薄层原始数据, 男17 例, 女33 例。将原始数据(DICOM格式)导入三维重建软件生成双侧股骨近端三维模型。在健侧生成骨折侧 的镜像模型并将其与健侧相配准, 使配准后的骨折侧镜像模型在CT 横截面图像上生成新的蒙罩, 在蒙 罩上进行关键点的标记, 通过软件三维测量技术计算股骨头空间移位参数, 并分析测量数据。 结果 嵌 插型骨折股骨头空间移位角度为17.17°±10.40°, 70%(35/50)的患者股骨头空间移位角度分布于10°~ 35°之间, 30%(15/50)的患者股骨头空间移位>20°;股骨头中心的移位距离为(6.49±3.60)mm, 股骨头小 凹最深点的移位距离为(10.42±5.92)mm。部分股骨颈嵌插型骨折存在很大的空间移位及成角, 将其完 全归类于Garden 玉型骨折存在一定的偏差。 结论 三维重建数字化测量技术能够更加准确、高效地测 量股骨颈骨折的真实空间移位程度。经典的股骨颈骨折Garden 分型对于嵌插型骨折的认识存在一定的 局限性;临床医生需重新认识嵌插型骨折, 从而制定更适宜的诊疗方案。