摘要
目的探讨桥接组合式内固定系统治疗股骨干骨折合并同侧股骨近端、股骨远端骨折的临床疗效。方法回顾性分析2013年1月至2016年12月于我院骨科接受手术治疗的4例股骨干骨折合并同侧股骨近端及远端骨折病人的临床资料,其中男3例,女1例,年龄为(33.5±9.3)岁(23~44岁),闭合性骨折3例,开放性骨折1例。3例病人存在合并损伤,其中颅脑损伤1例,胸腹部损伤1例,胫骨平台及骨盆骨折1例。入院后即确诊股骨近端骨折3例,延迟诊断1例,延迟时间为5 d。所有病例均采用桥接组合式内固定系统治疗。观察病人骨折愈合时间,末次随访采用Friedman-Wyman功能评分评价病人功能恢复情况。结果病人术后均获得随访,随访时间为(33.5±16.2)个月(20~57个月),手术时间为(193.3±36.2)min(155~241 min),术中出血量为(484.3±77.4)mL(415~582 mL)。2例病人骨折顺利愈合,股骨近端骨折于术后4~5个月愈合,股骨干骨折于术后6~7个月愈合,股骨远端骨折于术后5~6个月愈合。1例病人术后出现股骨头缺血性坏死,骨折愈合后将股骨内固定物全部取出,但股骨干再次出现骨折,再次手术后骨折愈合;1例病人术后出现股骨干骨不连,再次手术后骨折愈合。末次随访时Friedman-Wyman功能评分优1例,良2例,差1例,优良率为75%。结论股骨干骨折合并同侧股骨近端、股骨远端骨折较为罕见,股骨近端骨折漏诊率或延迟诊断率高,需要详尽的术前检查。桥接组合式内固定系统可作为治疗股骨干骨折合并同侧股骨近端、股骨远端骨折的一种选择。
Objective To discuss the effectiveness of the bridge-link type combined fixation system(BCFS)in treating ipsilateral fractures of proximal femur,shaft and distal femur.Methods From January 2013 to December 2016,4 cases of ipsilateral proximal femur,shaft and distal femur fractures treated were retrospectively analyzed.There were 3 males and 1 female,with age of(33.5±9.3)years(23-44 years).There were 3 closed fractures and 1 open fracture.Among them,3 patients had other combined injuries,including 1 case of craniocerebral injury,1 case of thoracic and abdominal injury,and 1 case of ipsilateral tibial and pelvic fracture.The proximal femur fractures were diagnosed in emergency in 3 cases,and delayed in 1 case.The delayed time was 5 days.All the cases were treated by plate system(BCFS system combined with reconstructing locking plates or cannulated screws).The fracture healing time was observed,and the functional recovery was evaluated by Friedman Wyman functional score at the last follow-up.Results All patients were followed up for(33.5±16.2)months(20-57 months),operation time was(193.3±36.2)min(155-241 min),intraoperative blood loss was(484.3±77.4)mL(415-582 mL).Fracture healing was successful in 2 patients.The proximal femur fracture healed at 4-5 months,the femoral shaft fracture healed at 6-7 months,and the distal femur fracture healed at 5-6 months.One patient presented avascular necrosis of the femoral head after surgery,and all the femoral internal fixations were removed after fracture healing,but the femoral shaft fracture occurred again,and the fracture healed after reoperation.One patient presented femoral shaft nonunion after surgery,and the fracture healed after reoperation.According to Friedman and Wyman classification,1 case had a good functional result,2 fair,and 1 poor at the final follow-up with good and fair rate being 75%.Conclusion Femoral shaft fractures with ipsilateral proximal and distal femur fractures are rare.The rate of missed diagnosis or delayed diagnosis of proximal femoral fractu
作者
薛超
刘晖
丁真奇
刘庆军
陈志达
吴进
XUE Chao;LIU Hui;DING Zhen-qi;LIU Qing-jun;CHEN Zhi-da;WU Jin(The 909th Hospital of PLA and the Orthopaedic Hospital of the Affiliated Southeast Hospital of Xiamen University,Zhangzhou 363000,China)
出处
《骨科》
CAS
2021年第2期149-154,共6页
ORTHOPAEDICS
