股骨重建钉治疗同侧股骨颈、干骨折

目的 探讨使用股骨重建钉内固定治疗同侧股骨颈、干骨折的临床疗效、手术要点和围手术期注意事项。方法 对12例使用股骨重建钉治疗的疗效进行回顾性分析。手术采用闭合穿钉、闭合或小切口切开复位，用三维瞄准器锁定远骨折端，股骨颈保持15。前倾角置人2枚拉力螺纹钉。结果 11例获得随访，随访平均时间12．3个月(6～58个月)。远期疗效按马元璋评定标准：优5例，良4例，可2例，优良率81．8％，平均股骨颈骨折临床愈合时间5．2个月、股骨干骨折临床愈合时间6．7个月，一期骨折愈合率达到72．7％，其中3例术后10，12，15个月远骨折段骨延迟愈合，改为动力固定，4～6个月后骨折愈合。无股骨头坏死征象。结论 股骨颈骨折强调不切开复位，并争取解剖复位；股骨干骨折则常规闭合穿钉、小切口复位、有限扩髓、静力固定。股骨重建钉是目前治疗股骨干粉碎性骨折伴同侧股骨颈骨折的有效方法。

Treatment of ipsilateral fractures of femoral neck and shaft by reconstruction interlocking nail

Objective To explore the clinical application of reconstruct ion interlocking nail in treating ipsilateral fractures of femoral neck and shaf t. Methods Twelve cases of ipsilateral fractures of femoral neck and shaft trea ted with reconstruction interlocking nail by static locking were reviewed. The d iaplasis of the fracture was done in a close manner or in an open manner but wit h a little incision, and the two sides of the fracture were locked with nails by a three-dimensional aim implement. Two lag screws were inserted into the femor al neck at a 15 degree dip angle. Results Eleven cases were followed up (average 12.3 months). Their long term effects were evaluated according to MaYuanzhang e valuation criteria: 5 cases gained excellent clinical results, 4 good, 2 fair; t he excellent and good rates were 81.8% (9/11). The average period of femoral n eck fracture healing was 5.2 months and that of shaft fracture healing 6.7 month s .72.7 % of the patients(8/11) showed fracture healing at one stage. There were no necrosis of femoral head, no femoral neck nonunion or malunion, or no n ail rupture. Conclusions Reconstruction interlocking nail is a principal way in treating ipsilateral fractures of femoral neck and shaft because of its effecti ve fixation and excellent clinical effect. Anatomy reduction of femoral neck and non-open reduction should be emphasized in treatment of femoral neck fractures , while close nail insertion, limited reaming and static locking should be a rou tine way in treatment of femoral shaft fractures.