CAJ | 학술논문

目的：探讨股骨重建钉治疗股骨干合并同侧髋部骨折的手术适应证。方法根据入选标准和排除标准，回顾2001年1月至2011年1月收治的股骨干合并同侧髋部骨折病例15例，其中男14例，女1例；年龄21~64岁，平均35.5岁。通过比较术前、术后即刻、术后1、3、6和12个月的临床和影像学随访结果，评估骨折愈合情况和并发症，分析股骨重建钉治疗股骨干合并同侧髋部骨折的最佳适应证。结果全部病例获得随访，随访时间14~48个月，平均27. 8个月。13例股骨干骨折一期获得骨性愈合，愈合时间（6.2±4.1）个月，14例股骨颈骨折一期获得骨性愈合，愈合时间（5.4±2.9）个月。合并症：1例股骨远端骨折由于狭部限制，重建钉过细，局部旋转不稳定，并发肥大性骨不连；1例股骨中段骨折延迟愈合；2例股骨干旋转畸形愈合；1例股骨颈头下型骨折不愈合。末次随访时进行 Fried-man-Wyman 评定，优12例，良 2例，差 1例，优良率93.3％。结论股骨重建钉适用于绝大部分股骨干骨折合并髋部骨折，尤其是股骨颈基底部骨折合并股骨干近端或狭部骨折。但对于股骨颈头下型、难复位的股骨颈骨折合并股骨干远端骨折，股骨重建钉并非最佳的治疗方案。
목적：탐토고골중건정치료고골간합병동측관부골절적수술괄응증。방법근거입선표준화배제표준，회고2001년1월지2011년1월수치적고골간합병동측관부골절병례15례，기중남14례，녀1례；년령21~64세，평균35.5세。통과비교술전、술후즉각、술후1、3、6화12개월적림상화영상학수방결과，평고골절유합정황화병발증，분석고골중건정치료고골간합병동측관부골절적최가괄응증。결과전부병례획득수방，수방시간14~48개월，평균27. 8개월。13례고골간골절일기획득골성유합，유합시간（6.2±4.1）개월，14례고골경골절일기획득골성유합，유합시간（5.4±2.9）개월。합병증：1례고골원단골절유우협부한제，중건정과세，국부선전불은정，병발비대성골불련；1례고골중단골절연지유합；2례고골간선전기형유합；1례고골경두하형골절불유합。말차수방시진행 Fried-man-Wyman 평정，우12례，량 2례，차 1례，우량솔93.3％。결론고골중건정괄용우절대부분고골간골절합병관부골절，우기시고골경기저부골절합병고골간근단혹협부골절。단대우고골경두하형、난복위적고골경골절합병고골간원단골절，고골중건정병비최가적치료방안。
Objective To review our experience with reconstruction intramedullary nailing in the treatment of ipsilateral hip and femoral shaft fractures. Methods From Jan 2001 to Jan 2011,fifteen patients with ipsilateral hip and femoral shaft fractures were treated with reconstruction intramedullary nails and followed-up in our division. Patients were evaluated at 1,3, 6,12 months after surgery,and then every year postoperatively. Results All patients were followed-up for an average of 27. 8 months(range,14 ~ 48 months). Neck fractures healed in 14 patients,and shaft fractures healed in 13 patients. The average u-nion time was 5. 4 months for the hip fractures and 6. 2 months for the shaft fractures. There was one case of non-union of the femoral neck fracture and one case of nonunion and one case of delayed union and two cases of malunion of femoral shaft frac-tures. Conclusion Reconstruction intramedullary nail has been an excellent choice for most cases of ipsilateral hip and femo-ral shaft fractures,but should not be preferred in subcapital fractures or irreducible femoral neck fractures and distal femoral shaft fractures.