髋臼骨折后的全髋关节置换

发布时间：2018-03-03 18:17

本文选题：髋臼骨折　切入点：股骨头坏死　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨髋臼骨折后解剖结构的变化,行全髋关节置换术的特点及其髋臼侧的重建方法方法:自2012年1月至2016年6月期间收治入院、明确诊断为髋臼骨折后股骨头坏死或创伤性关节炎进行全髋关节置换的17例患者的临床资料、髋臼侧基本未受影响的单侧股骨头坏死行全髋关节置换的17例患者的临床资料,将既往有髋臼骨折病史的患者分为实验组,另一组为对照组。统计对照组与实验组患者术前术后髋关节Harris评分、关节活动范围;统计两组患者的手术时间、出血量、抗生素应用时间、术后出现的并发症(术后脱位、假体感染、异位骨化、假体松动);统计两组患者术前、术后患侧与健侧下肢长度差值(双侧小粗隆高点与髂嵴最高点连线距离);统计两组患者术后患侧与健侧的股骨偏心距;统计两组患者术前、术后旋转中心到泪滴连线(过健侧泪滴下缘与髂嵴最高点连线的平行线)的垂直距离、水平距离。结果:实验组患者髋关节Harris评分由术前平均37.1分提高到术后末次随访平均83.2分;对照组患者髋关节Harris评分由术前平均40.8分提高到术后末次随访平均86.4分。两组患者髋关节活动范围在前屈、内收、外展、旋转方面较术前有了明显的改善。实验组患者平均手术时间137分钟,术中平均出血量941 ml,抗生素应用时间平均3天,双下肢长度差值术后平均为5.8 mm,患侧术后股骨偏心距平均42.3mm(健侧为43.2mm),术后患侧旋中心到泪滴连线的水平距离平均35.6 mm(健侧为35.1 mm),垂直距离平均17.4 mm(健侧为18.0 mm);对照组患者平均手术时间95分钟,术中平均出血量294 ml,抗生素应用时间平均2天,双下肢长度差值术后平均为6.5 mm,患侧术后股骨偏心距平均43.1mm(健侧为42.7mm),术后患侧旋转中心到泪滴连线的水平距离平均34.1 mm(健侧为34.8mm),垂直距离平均17.6 mm(健侧为17.8 mm)。两组患者术后的髋关节Harris评分、关节活动范围较术前得到明显提高。对照组在手术时间、出血量、抗生素应用时间、术后出现的并发症上均较实验组少。两组患者术后双下肢肢体长度差值较术前减小,均有效的重建了髋关节旋转中心。结论:1.全髋关节置换术对髋臼骨折后创伤性关节炎或股骨头坏死的晚期的治疗具有良好的疗效。2.髋臼骨折后髋臼的解剖结构发生变化,对髋臼解剖结构的再认识是手术的核心问题。3.一些髋臼骨折后的患者髋臼结构的改变具有不可复性,保证关节置换时髋臼杯的良好覆盖和有效支撑是需要重点关注的问题。
[Abstract]:Objective: to investigate the changes of anatomical structure after acetabular fracture, the characteristics of total hip arthroplasty and the reconstruction methods of acetabular side: from January 2012 to June 2016, the patients were admitted to hospital. Clinical data of 17 cases of total hip replacement diagnosed as osteonecrosis of femoral head or traumatic arthritis after acetabular fracture. Clinical data of 17 cases of unilateral femoral head necrosis with basically unaffected acetabular side undergoing total hip replacement. The patients with previous history of acetabular fracture were divided into experimental group and control group. The Harris score of hip joint and the range of motion of hip joint were measured before and after operation in the control group and the experimental group, and the time of operation and the amount of bleeding in the two groups were counted. The duration of antibiotic use, postoperative complications (postoperative dislocation, prosthetic infection, ectopic ossification, prosthesis loosening); The difference of leg length between the affected side and the healthy side after operation (the distance between the bilateral trochanteric height and the highest point of iliac crest); the eccentricity of femur between the affected side and the healthy side of the two groups after operation were counted; The vertical distance from the center of rotation to the line of tear drops (the parallel line between the lower edge of the tear drop and the highest point of iliac crest), Results: the Harris score of hip joint in the experimental group increased from 37.1 before operation to 83.2 at the last follow-up. The Harris score of hip joint in the control group was increased from 40.8 before operation to 86.4 at the last follow-up. The range of hip joint activity in the two groups was anterior flexion, adduction and abduction. The mean operation time was 137 minutes, the average intraoperative bleeding was 941 ml, and the mean time of antibiotic application was 3 days. The average length difference of the lower limbs was 5.8 mm, the average eccentric distance of the affected side was 42.3 mm (the healthy side was 43.2 mm), the horizontal distance from the center of circumflex to the line of tear drops was 35.6 mm (the normal side was 35.1 mm, the vertical distance was 17.4 mm (the healthy side was 18.0 mm). The average operation time of the patients in the radiation group was 95 minutes. The average intraoperative bleeding was 294 ml, and the mean time of antibiotic application was 2 days. The average length difference of the lower limbs was 6.5 mm, the average eccentric distance of the affected side was 43.1 mm (the healthy side was 42.7 mm), the horizontal distance from the center of rotation to the line of tear drops was 34.1 mm (the healthy side was 34.8 mm, the vertical distance was 17.6 mm (the healthy side was 17.8 mm). Harris score of hip joint after operation, The operation time, bleeding volume, antibiotic application time and postoperative complications in the control group were less than those in the experimental group. The difference of limb length between the two groups was decreased. Conclusion Total hip arthroplasty is effective in the treatment of traumatic arthritis or late necrosis of femoral head after acetabular fracture. Recognition of acetabular anatomical structure is the core of the operation. 3. Some patients with acetabular fracture have irreducible acetabular structure changes. It is necessary to pay attention to ensure good cover and effective support of acetabular cup during joint replacement.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

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