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| 題 名 | Treatment of Ipsilateral Femoral Neck and Shaft Fractures=同側性股骨頸及股骨幹骨折之治療 |
|---|---|
| 作 者 | 張櫻霖; 李土生; 楊大中; | 書刊名 | 中華民國外科醫學會雜誌 |
| 卷 期 | 28:5 民84.09-10 |
| 頁 次 | 頁361-368 |
| 分類號 | 416.26 |
| 關鍵詞 | 同側性股骨頸; 股骨幹骨折; Ipsilateral femoral neck fracture; Shaft fracture; |
| 語 文 | 英文(English) |
| 中文摘要 | 同側性股骨頸合併股骨幹骨折是一種在診斷及治療上較少見但複雜的組合,對大部分骨科醫師來說治療此種骨折仍有許多挑戰性。此篇文章乃提出我們對此種骨折的治療方式及經驗。 從1983年1月至1993年1月,共有13位患有同側股骨頸合併股骨幹骨折的病患,1位失去連繫,有6位男性及6位女性,平均年齡為43.0 (21-90)歲,受傷的機轉包括10位受到機動車車禍, 1 位是由於高處落下,另1位是跌倒造成。有1位股骨頸骨折者於治療之初被忽略掉。平均延遲手術時間為5.3(1-18)天,11位病患的平均追踪時間約為28.5 (6-64)個月,另一位病患於出院一個月後因其它原因病逝。將病人分成四組,第一組有七位病人接受銅板固定股骨骨折,用A.O.拉力髖部骨釘或多支螺釘固定頸部骨折。第二組有三位病人接受股骨骨髓內釘固定再上多支螺釘固定頸部骨折。第三組有一位病接受兩支Ender's氏髓內釘固定,第四組有一位病人接受骨骼牽引治療。 第一組有6位股骨頸骨折得到癒合,平均癒合時間為3.67±2.07個月,7位股骨幹骨折皆有癒合,其平均癒合時間為8.00±5.32個月,第二組三位股骨頸骨折平均癒合時間為6.00±3.46個月,骰骨幹骨折平均癒合時間為4.67±2.08個月。第三組病人發生乏血性股骨頭壞死,接受全髖關節置換術,第四組病人於出院後一個月因其它原因死亡。有6例併發症。術後功能的恢復,有9例屬於好的功能恢復,1例普通,1例不好的功能恢復。 由於大多數的骨科醫師對此種骨折的警覺性較以往高,所以忽略掉股骨頸骨折的情況已較少發生。我們的治療結果顯示股骨骨折處給予先用銅板固定,再加上A.O.活動式拉力骨釘或多支螺釘固定頸部骨折,可得到頸部骨折較高的癒合率,此種治療方式對使用骨髓內釘植入再加上多支螺釘固定這種較需技巧的手術方式來說為另一種良好的治療選擇。 |
| 英文摘要 | Ipsilateral femoral neck and shaft fractures are a rare but complex fracture combination. Management of such double fractures is still a challenge to most orthopaedists. From January 1983 to January 1993, 13 patients with ipsilateral femoral neck and shaft fractures were treated here. One patient was lost to follow-up. Treatment modalities could be divided into four groups. It was found that shorter union time of neck fracture could be achieved for patients undergoing broad dynamic compression plate (DCP) fixation for shaft fractures and dynamic hip screw(DHS) or multiple screws for neck fracture. But shorter union time of shaft fracture was noted for patients undergoing antegrade Küntscher nailing or static interlocking nailing and multiple screws for neck fractures. Retrograde nailing with two Ender's pins was done in one patient, but aseptic necrosis of femoral head was noted two years later, and total hip arthroplasty was performed. Close reduction and skeletal traction were done in one patient for her poor general condition. Complications occurred in sex cases. Functional outcome was good in nine, fair in one and poor in one patient. Results here suggest that plating of femoral shaft fractures with supplementary dynamic hip screw or multiple screw fixation of neck fracture may result in a higher union rate of neck fracture. Furthermore, this is a good alternative treatment method when compared with the high-technique, demanding antegrade Kuntscher nailing or interlocking nailing with supplementary multiple screw pinning. |
本系統中英文摘要資訊取自各篇刊載內容。