摘要
【摘要】 目的 比较股骨近端顺向长髓内钉和股骨远端逆向髓内钉联合空心拉力螺钉治疗股骨干合并同侧股骨颈骨折的疗效。方法 回顾性分析2007年1月至2016年1月治疗的42例股骨干合并同侧股骨颈骨折随访资料完整的患者资料。根据不同固定方法将患者分为两组：其中20例采用单枚股骨近端长髓内钉顺向置入固定,即单枚髓内钉组,男15例,女5例,平均年龄39.4岁;股骨干骨折AO分型,A型4例,B型9例,C型7例;股骨颈骨折Garden分型,Ⅰ和Ⅱ型14例,Ⅲ和Ⅳ型6例。22例采用股骨远端逆向髓内钉联合股骨颈空心螺钉固定,即联合内固定组,男17例,女5例;平均年龄42.2岁;股骨干骨折AO分型,A型3例,B型10例,C型9例;股骨颈骨折Garden分型,Ⅰ和Ⅱ型16例,Ⅲ和Ⅳ型6例。两组患者在性别、年龄、骨折分型方面无统计学差异。比较两组患者的切口长度、手术时间、术中出血量、骨折愈合时间、术后负重时间、内固定稳定性、髋关节Harris功能评分、膝部疼痛及其他术后并发症发生率。结果 42例患者均顺利出院,术后随访时间12~22个月,平均14.6个月。单枚髓内钉组的手术时间[（75.0± 10.2） min]、术中出血量[（150.6± 80.4） ml]、髋关节Harris评分优良率（80.0%）、术后3个月膝部疼痛发生率（10.0%）显著低于联合内固定组[（105.2± 18.4） min、（180.0± 56.8） ml、86.4%、31.8%],切口长度[（8.3± 1.4） cm]显著长于联合内固定组[（4.0± 0.6） cm];单枚髓内钉组和联合内固定组患者的骨折愈合时间[（20.0± 4.0）周和（19.6± 4.2周）]、术后负重时间[（8.2± 4.0）周和（8.0± 4.2）周]无显著性差异。两组患者主要并发症为骨折延迟愈合（单枚髓内钉组3例、联合内固定组1例）、骨折不愈合（单枚髓内钉组1例）和髋内翻（单枚髓内钉组1例）。单枚髓内钉组并发症发生率（30%,6/20）显著高于联合内固定组（4.5%,1/22）,主�
Objective To compare the effect of proximal femoral intramedullary nail fixation and femoral retrograde intramedullary nail combined with hollow lag screw fixation in the treatment of ipsilateral femoral neck and shaft fractures. Methods Data of 42 patients with ipsilateral femoral neck and shaft fractures who were admitted in our hospital from January 2007 to January 2016 were retrospectively analyzed. According to different fixation methods, the patients were divided into two groups： single intramedullary nail group （SIN group） （20 cases, treated with single proximal femoral intramedullary nail, 15 males and 5 females with an average age of 39.4）; combined internal fixation group （CIF group） （22 cases, treated with femoral distal intramedullary nail combined with femoral neck hollow lag screw, 17 males and 5 females with an average age of 42.2 years）. In the SIN group, 4 cases were type A, 9 cases type B, 7 cases type C according to AO classification. And 14 cases belonged to I or II （stable fracture）, 6 cases of type III or IV （unstable fracture） according to Garden classification. In the CIF group, 3 cases were type A, 10 cases type B, 9 cases type C according to AO classification. And 16 cases belonged to type I or type II, 6 cases type III or IV according to Garden classification. The incision length, operation time, intraoperative blood loss, fracture healing time, postoperative weight time, stability of internal fixation, hip function score, pain in the knee and postoperative complication rate were compared between the two groups. Results There was no significant difference in gender, age and fracture classification between the two groups. The operation time （75.0±10.2 min） , intraoperative blood loss （150.6±80.4 ml）, hip Harris score excellent rate （80%） of incidence of knee pain in postoperative 3 months （10.0%） of the SIN group were significantly lower than those of the CIF group （105.2±18.4 min, 180.0±56.8 ml, 86.4% and 31.8%）. The length of incision �
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2017年第17期1081-1087,共7页
Chinese Journal of Orthopaedics
关键词
股骨骨折
股骨颈骨折
骨折固定术
髓内
骨螺丝
Femoral fractures
Femoral neck fractures
Fracture fixation, intramedullary
Bone screws
