网络数据来源的股骨干合并同侧股骨颈骨折的诊断与治疗

目的 以网络开放数据库为基础,探讨股骨干合并同侧股骨颈骨折的诊断与治疗策略.方法 筛选2005年11月1日至2008年12月31日中华骨科网(htpp://www.orthochina.org)骨科创伤版数据库中128例股骨颈骨折患者资料,均由通过"骨科医生"身份验证的专业骨科医生提交,提取18例股骨干合并同侧股骨颈骨折患者资料.利用网络开放数据库的特点,综合分析此18例患者的医院分布、漏诊时间和漏诊原因,总结及汇总论坛讨论意见,分析骨科医生对股骨干合并同侧股骨颈骨折的认识,汇总治疗策略.结果 股骨干合并同侧股骨颈骨折占股骨颈骨折的14.1%(18/128).38.9%(7/18)的患者漏诊股骨颈骨折,1例为术巾漏诊,6例为术后漏诊.18例患者中,来自基层一级医疗机构者3例,地区二级医院12例,三级甲等医院3例.7例漏诊患者中,基层一级医疗机构3例,地区二级医院1例,三级甲等医院3例.早期确诊的11例患者多采用钢板加空心加压螺纹钉固定或股骨近端髓内钉固定,疗效可靠.1例术中漏诊患者术中补救后复位固定满意.6例术后漏诊患者中,3例采用空心加压螺纹钉同定,骨折复位较好;3例未对股骨颈骨折固定,预后较差.医生查体不完全、尤摄髋CT和术中透视及复查X线没有包括同侧髋关节是漏诊的主要原因.结论 网络数据库客观反映目前临床诊疗中股骨干合并同侧股骨颈骨折的重要性和风险,漏诊患者中顺行髓内钉的翻修最为困难,早期诊治及避免漏诊十分必要,应强调规范化查体和诊治.

Diagnosis and treatment of ipsilateral fractures of femoral neck and shaft: a discussion based on an internet database

Objective To discuss diagnosis and treatment of ipsilateral fractures of femoral neck and shaft based on an internet orthopaedic trauma database.MethodsWe searched Ihrough htpp://www.orthochina.ors for papers on diagnosis and treatment of fractures of femoral shaft which were published from 1st November,2005 to 31st December,2008.We collected 128 cases of femoral shaft fractures.including 18 cager of ipsilateral fractures of femoral neck and shaft,Their diagnoses and treatments were analyzed in terms of geographic distribution of hospital,ranking of hospital,treatment protocols and intemal fixations. Results 14.1%(18/128)of the femoral shaft fractures were simultaneously coupled with ipsilateral femoral neck fracture.38.9%(7/18)of the ipsilateral fractures of femoral neck and shaft had been overlooked.Of the 7 neglected cases,only one was found intra-operatively and repaired,6(85.7%)remained untreated after fixation for the femoral shaft fracture.The neglects were committed by surgeons-in-charge from Grade 2 hospitals.Eleven cases whose ipsilateral fractures of femoral neck and shaft had been diagnosed early enjoyed good longterm results after plate fixation for the shaft fracture and cannulated lag screws for the neck fracture or proximal femoral nailing(PFN)for both neck and shaft fractures.Of the 6 neglected cases,3 received fixation with cannulated lag screws in revision but could not walk independently 9 months after surgery,and 3 suffered from femoral head necrosis after conservative treatment without further internal fixation.Conclusions The internet database highlights a petential risk of neglcoting ipsilateral fractures of femoral neck and shaft and poor consequences of revision. Measures must be taken to prevent misdiagnosis and overlook of the femoral neck fracture complicated with the femoral shaft fracture.