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两种手术方法治疗股骨干合并同侧股骨颈骨折疗效比较 张建政 刘智 孙天胜 李连华 叶超群 任继鑫 胥少汀 作者单位：100700 北京军区总医院全军创伤骨科研究所 [摘要] 目的 比较股骨重建钉和逆行髓内钉加空心钉治疗股骨干合并同侧股骨颈骨折的疗效，探讨各自的手术适应证。方法 根据病例选择标准，回顾2001年1月至2010年5月收治21例股骨干合并同侧股骨颈骨折，采用股骨重建钉固定10例，逆行髓内钉加空心钉固定11例。两组性别、年龄、合并伤、骨折部位、骨折类型的差异无统计学意义（P＞0.05）。术后1、3、6、9、12及以后每年1次影像学和临床功能随访，通过临床和影像学评估骨折愈合情况和并发症，分析比较骨折部位、类型与内固定方式的关系。结果 21例患者随访12～48个月，平均27.1个月。两组在手术时间、术中出血量、术后引流血量、股骨干、股骨颈骨折愈合时间、Friedman-Wyman功能评定等无统计学意义（P＞0.05）。股骨重建钉组住院费用高于逆行髓内钉加空心钉组，有统计学意义（t=16.71，P=0.016）。两组股骨干骨折愈合率（X2=0.005， P=0.943）、股骨颈骨折愈合率（X2=1.155，P=0.282）均无统计学意义。股骨重建钉组并发股骨干萎缩性骨不连1例，股骨颈骨折不愈合1例，旋转畸形愈合2例。逆行髓内钉加空心钉组并发股骨干延迟愈合1例，肢体短缩3例，膝关节痛2例，伸膝装置粘连1例。结论：股骨干骨折合并股骨颈骨折的治疗应采取个体化原则，股骨重建钉更适用于股骨颈基底部骨折合并狭部及狭部以近的股骨干骨折，对于头下型、难复位的股骨颈骨折合并股骨干远端骨折或需要同时处理的膝关节内损伤、关节周围骨折的患者，逆行髓内钉加空心钉更为理想。 【关键词】?股骨干骨折；股骨颈骨折；骨折固定术；内 Ipsilateral Femoral Neck and Shaft Fractures: a Retrospective Analysis of Two Treatment Methods ZHANG Jian-zheng, LlU Zhi, SUN Tian-sheng,LI Lian-hua,YE Chao-qun REN Ji-xin,XUN Shao-ting.Department of Orthopaedics, General Hospital of Beijing Military Command, Beijing 100700, China [Abstract] Objective To compare the results and indications between reconstruction type intramedullary nailing and retrograde intramedullary nailing and lag screw fixation in the treatment of ipsilateral femoral neck and shaft fractures. Methods From Jan 2001 to May 2010,twenty-one patients with ipsilateral femoral neck and shaft fractures were treated and followed-up in our division. Group Ⅰ included 10 patients who underwent surgery with reconstruction intramedullary nails. Group Ⅱ included 11 patients who underwent surgery with retrograde intramedullary nails combined with cancellous lag screws. There were no significant differences between the two groups with respect to gender，age, associated injuries, anatomical location and type of fracture. Patients were evaluated at 1,3, 6, 9, 12 months after surgery, and then every year postoperatively. Fisher exact test and t-test were performed to compare the rate of union and complications.