股骨干骨折合并同侧股骨颈骨折的诊断与手术治疗

[目的]探讨同侧股骨干、股骨颈骨折的临床特点、漏诊原因及治疗方法和疗效.[方法]回顾性分析2000年3月至2007年9月本院11例股骨干骨折合并同侧股骨颈骨折的临床资料,男8例,女3例;平均年龄32（25～57）岁.受伤原因：交通伤7例,高处坠落伤4例.术前诊断5例,术中诊断3例,术后诊断3例,其中2例采用股骨重建髓内钉同时固定股骨干和股骨颈,2例采用动力髋（DHS）固定,1例采用空心钉固定股骨颈骨折,再行闭合复位逆行带锁髓内钉固定股骨干骨折,2例采用顺行带锁髓内钉（UFN）结合空心钉或克氏针固定,1例合并髁上骨折,采用股骨髁解剖板固定股骨干和股骨髁上骨折,空心钉固定股骨颈,3例采用动力加压钢板（LC-DCP）固定3～35 d后发现股骨颈骨折,再行空心钉或克氏针固定.[结果] 同侧股骨干、股骨颈骨折常难以做出正确诊断,股骨颈骨折漏诊率较高,本组病人漏诊率27.3%,股骨干骨折多为粉碎性骨折,股骨颈骨折多为无移位骨折,术后随访2～5年,平均3.3年,内固定治疗效果满意,骨折均达骨性愈合,无股骨头坏死,关节功能恢复好,Harris评分平均92分.[结论] 对高能量损伤引起的股骨干骨折,要分析其受伤机制,仔细进行体格检查,常规拍摄髋关节X线平片,必要时行CT或MRI检查,骨折均应早期内固定手术治疗.

Diagnosis and Surgery of Femoral Shaft Fracture Complicated with Ipsilateral Femoral Neck Fractures

[Objective]To explore the clinical features, reasons of missed diagnosis, treatment method and therapeutic effect of femoral shaft fracture complicated with ipsilateral femoral neck fracture. [Methods] Eleven cases of ipsilateral fractures of femoral neck and shaft treated from March 2000 to September 2007 were retrospectively reviewed. The causes were communication wound（7 cases） and high falling injury（4 cases）. Five cases of neck fracture were diagnosed before operation, 3 during operation and 3 after operation. Among the 11 cases, 2 cases were treated with interlocking intramedullary nails, 2 dynamic hip system（DHS）, 1 canulated screws to fix neck fracture combined with closure reduction and retrograde interlocking intramedullary nail to fix shaft fracture, 2 anterograde interlocking intramedullary nail（UFN） combined with hollow nail or Kirschner wire to fix. Only one case complicated with supracondylar fracture was treated with femoral condyle plate to fix shaft and supracondylar fracture combined with hollow nail to fix the neck fracture. And the other 3 cases were initially treated with LC-DCP to fix, and after 3~35 days, neck fracture was fixed with hollow nail or Kirschner wire. [Results]The ipsilateral fracture of femoral neck and shaft was rare and easy to be missed diagnosis. The rate of missed diagnosis of neck fracture in these patients was 27.3%. Most of shaft fractures were comminuted fractures. Most of neck fractures were incomplete fractures. All cases were followed up for 3.3 years（2~5years）. Internal fixation had satisfactory effect. All fractures had bone union. No femoral head necrosis was found and the joint function reeovery was satisfactory. Harris score was 92. [Conclusion]For the femoral shaft fraeture caused by high-energy injury should be considered carefully. Its injury mechanism should be analyzed. Strict physical examination and routine X-film of hip joint should be done. CT or MRI should be taken when necessary. Early internal fixation should be performed for all fractures.