髋臼骨折内固定失败术后的全髋关节置换术

发布时间：2018-02-16 04:46

本文关键词： 关节成形术置换髋髋臼骨折骨折固定术内　出处：《中国骨伤》2016年11期 　论文类型：期刊论文

【摘要】：目的:探讨髋臼骨折内固定失败术后继发创伤性关节炎和(或)股骨头缺血性坏死行全髋关节置换术的特点及临床疗效。方法:2009年2月至2014年10月,采用全髋关节置换术对31例(31髋)髋臼骨折内固定失败继发创伤性关节炎和(或)股骨头缺血性坏死患者进行治疗,其中男26例,女5例;受伤时平均年龄(41±12)岁。患者因髋臼骨折内固定术后3~132个月,平均(20.6±26.9)个月内继发创伤性关节炎和(或)股骨头缺血性坏死而行全髋关节置换术,全髋关节置换术均采用后外侧入路。观察术后并发症和关节活动度,并比较术前和术后随访时髋关节VAS疼痛评分和Harris髋关节评分。结果:术后27例获得随访,随访时间12~80个月,平均(43.2±11.7)个月。其中出现关节感染1例,假体松动1例,脱位1例,无继发坐骨神经损伤病例发生。所有随访病例髋关节功能和步态有明显改善;至末次随访时,VAS由术前平均(7.6±1.2)分,降低到术后平均(1.2±0.9)分,Harris评分由术前平均(45.5±13.6)分,提高到术后平均(88.5±7.8)分,差异均有统计学意义(P0.01)。髋关节除后伸外,前屈、外展、内收、内旋及外旋活动范围较术前显著增加,差异有统计学意义(P0.05)。X线片复查示:髋臼假体无不稳定发生,1例股骨柄假体下沉3 mm,2例发生异位骨化。结论:正确处理内固定物,提防潜在感染,合理重建髋臼骨缺损,是髋臼骨折内固定失败术后全髋关节置换成功的关键。
[Abstract]:Objective: To investigate the failed internal fixation of Acetabular Fractures Postoperative traumatic arthritis and (or) characteristics of femoral head avascular necrosis underwent total hip replacement surgery and clinical curative effect. Methods: from February 2009 to October 2014, the total hip arthroplasty in 31 cases (31 hips) acetabular fracture internal fixation failure secondary to traumatic arthritis and (or) avascular necrosis of the femoral head were treated, including 26 cases of male, female 5 cases; mean age was (41 + 12) years old. Patients with acetabular fractures after internal fixation for 3~132 months, average (20.6 + 26.9) secondary to trauma arthritis and inflammation within a month (or) of avascular necrosis of the femoral head and total hip arthroplasty, total hip arthroplasty using posterolateral approach. Observation of postoperative complications and joint activity, follow-up and comparison of preoperative and postoperative VAS hip score and Harris hip score. Results: after operation, 27 cases were followed up. 12~80 months, the average (43.2 + 11.7) months. Among 1 cases of joint infection, prosthesis loosening in 1 cases, 1 cases of dislocation, no cases of secondary sciatic nerve injury occurred. All the cases of hip joint function and gait improved significantly; at the last follow-up, the mean preoperative VAS (7.6. 1.2), to reduce the average postoperative (1.2 + 0.9) points, Harris score from preoperative average (45.5 + 13.6) points, to improve the postoperative average (88.5 + 7.8), the differences were statistically significant (P0.01). In addition to the hip flexion, flexion, abduction, adduction, internal rotation the scope of activities and external rotation significantly increased, the difference was statistically significant (P0.05). The X-ray films showed that the acetabular component is stable, 1 cases of femoral prosthesis sinking 3 mm, 2 cases of heterotopic ossification. Conclusion: the correct treatment of internal fixation, beware of latent infection, reasonable reconstruction of acetabular bone defect is closed total hip acetabular fracture internal fixation failure after operation The key to the success of the joint replacement.

【作者单位】：中国人民解放军总医院骨科;
【分类号】：R687.4

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