闭合复位髓内钉固定治疗同侧股骨干合并股骨粗隆间骨折的临床疗效与不愈合危险因素分析

目的　评估闭合复位髓内钉治疗同侧股骨干骨折合并股骨粗隆间骨折的临床疗效并分析造成骨折不愈合的危险因素。 方法　回顾性分析2010年1月至2016年12月在我院行闭合复位髓内固定治疗同侧股骨干骨折合并髋部骨折的31例患者，男23例，女8例，年龄(46.4±15.7) 岁（21~73岁）。观察并记录股骨干合并股骨粗隆间骨折患者阻挡钉数量、手术时间、失血量、愈合时间、肢体短缩、髋关节HHS功能评分。对可能造成骨折不愈合的可能因素进行单因素及多因素分析。 结果　所有患者随访时间12~48个月，平均随访时间20.1个月。对所有造成骨折不愈合的可能因素进行分析。阻挡钉数量和骨折类型具有统计学意义(P<0.05)，其余因素如损伤机制、手术时间等未见明显统计学意义(P>0.05)。对上述两因素进行多因素分析，阻挡钉数量(OR=2.845, 95% CI 2.164~3.741)和骨折类型(OR=3.388，95% CI 1.966~5.840)为独立危险因素。 结论　阻挡钉数量少、股骨干粉碎型骨折是引起骨折不愈合的独立危险因素。闭合复位髓内钉治疗同侧股骨干合并股骨粗隆间骨折安全有效、可提高生活质量，值得临床广泛推广。

Analysis of clinical efficacy and nonunion risk factors of closed reduction and intramedullary nailing in the treatment of ipsilateral femoral shaft with intertrochanteric fracture

Objective　To evaluate the clinical efficacy of closed reduction intramedullary nailing in the treatment of ipsilateral femoral shaft fracture with intertrochanteric fracture and to analyze the risk factors for fracture nonunion.　Methods　A retrospective analysis was performed on 31 patients (23 males and 8 females, aged from 21 to 73 years old who underwent closed reduction and intramedullary fixation for ipsilateral femoral shaft fracture with intertrochanteric fracture in our hospital from January 2010 to December 2016. The intramedullary nail type, number of blocking nails, operation time, blood loss, healing time, limb shortening and hip joint HHS function score in femoral shaft patients with intertrochanteric fractures were observed and recorded. The possible factors of fracture nonunion were analyzed by single factor and multiple factors.　Results　All patients were followed up for 12 to 48 months, with an average of 20.1 months. Possible causes of fracture nonunion were analyzed. There were statistical significance in the number of blocking nails and fracture type (P<0.05), while there was no statistical significance in other factors such as injury mechanism, and operation time (P>0.05). Multivariate analysis was conducted for the above two factors. The number of blocking nails (OR=2.845, 95% CI 2.164-3.741) and fracture type (OR=3.388, 95% CI 1.966~5.840) were the independent risk factors. Conclusions The independent risk factors of fracture nonunion are the small number of blocking nails and the comminuted fracture of femoral shaft. Closed reduction intramedullary nailing in the treatment of ipsilateral femoral shaft with intertrochanteric fracture is safe and effective and can improve the quality of life.