CAJ | 학술논문

目的比较股骨重建钉与逆行髓内钉加空心钉治疗股骨于合并同侧股骨颈骨折的疗效,探讨各自的手术适应证.方法回顾性分析2001年1月至2010年5月收治的21例股骨干合并同侧股骨颈骨折患者资料,采用股骨重建钉固定10例(股骨重建钉组),逆行髓内钉加空心钉固定11例(逆行髓内钉加空心钉组).两组患者术前一般资料差异均无统计学意义(P＞0.05),具有可比性.术后1、3、6、9、12个月及以后每年随访1次,通过临床和影像学评估骨折愈合情况和并发症的发生情况.结果 21例患者术后获12 ～48个月(平均27.1个月)随访.两组患者在手术时间、术中出血量、术后引流量、住院时间、股骨干骨折愈合时间、股骨颈骨折愈合时间及Friedman-Wyman功能评定结果等方面差异均无统计学意义(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,差异有统计学意义(t=16.710,P=0.016).两组股骨干骨折愈合率(9/10 vs.10/11)、股骨颈骨折愈合率(9/10 vs.11/11)差异均无统计学意义(P＞0.05).股骨重建钉组4例发生并发症,逆行髓内钉组7例发生并发症.结论股骨干合并同侧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同侧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.
목적 비교고골중건정여역행수내정가공심정치료고골우합병동측고골경골절적료효,탐토각자적수술괄응증.방법 회고성분석2001년1월지2010년5월수치적21례고골간합병동측고골경골절환자자료,채용고골중건정고정10례(고골중건정조),역행수내정가공심정고정11례(역행수내정가공심정조).량조환자술전일반자료차이균무통계학의의(P＞0.05),구유가비성.술후1、3、6、9、12개월급이후매년수방1차,통과림상화영상학평고골절유합정황화병발증적발생정황.결과 21례환자술후획12 ～48개월(평균27.1개월)수방.량조환자재수술시간、술중출혈량、술후인류량、주원시간、고골간골절유합시간、고골경골절유합시간급Friedman-Wyman공능평정결과등방면차이균무통계학의의(P＞0.05).고골중건정조주원비용고우역행수내정가공심정조,차이유통계학의의(t=16.710,P=0.016).량조고골간골절유합솔(9/10 vs.10/11)、고골경골절유합솔(9/10 vs.11/11)차이균무통계학의의(P＞0.05).고골중건정조4례발생병발증,역행수내정조7례발생병발증.결론 고골간합병동측고골경골절적치료응채취개체화원칙.고골중건정경괄용우고골경기저부골절합병협부급협부이근적고골간골절；대우두하형、난복위적고골경골절합병동측고골간원단골절혹수요동시처리적슬관절내손상、관절주위골절적환자,역행수내정가공심정경위이상.
Objective To compare the outcomes and indications between intramedullary reconstruction nailing and retrograde intramedullary nailing plus lag screw fixation in the treatment of ipsilateral femoral neck and shaft fractures.Methods From January 2001 to May 2010,21 patients with ipsilateral femoral neck and shaft fractures were treated in our division.Ten of them underwent intramedullary reconstruction nailing(Group Ⅰ)and 11 underwent retrograde intramedullary nailing plus cancellous lag screw fixation(Group Ⅱ).There were no significant differences between the 2 groups with respect to gender,age,associated injury,anatomical location and type of fracture(P ＞ 0.05).The 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 their rates of union and complications.Results The average follow-up was 27.1months(range,from 12 to 48 months)for the 21 patients.An unpaired t-test showed no significant differences with respect to follow-up time,operation time,intraoperative blood loss,postoperative drainage,time for radiographic union,time for clinical union and Friedman-Wyman score between the 2 groups(P ＞ 0.05).The hospitalization cast was significantly higher for Group I than for Group Ⅱ(t =16.710,P =0.016).There were no significant differences in either the rate of femoral shaft union(9/10 vs.10/11)or the rate of femoral neck union(9/10 vs.11/11)(P ＞ 0.05).Four postoperative complications occurred in Group I and 7 in Group Ⅱ.Conclusions The treatment choice for ipsilateral femoral neck and shaft fractures should depend on specific cases.Intramedullary reconstruction nailing should not be preferred in subcapital fractures or irreducible femoral neck fractures,while retrograde intramedullary nailing plus cancellous lag screw fixation may be an excellent choice for subcapital neck fractures and for distal femoral shaft fractures associated with distal femoral supracondylar or proximal tibial fractures.