摘要
目的 探讨采用全髋关节置换术治疗同侧髋臼合并股骨头骨折内固定术后继发创伤性髋关节强直的手术方法及临床疗效.方法 2009年10月至2015年1月对7例同侧髋臼合并股骨头骨折内固定术后继发创伤性髋关节强直的患者行全髋关节置换,男6例,女1例;年龄25～51岁,平均38岁.左髋4例,右髋3例.所有患者均接受过1～2次骨折切开复位内固定术,1例术后出现髋部深层慢性感染,6例接受过内固定取出术.7例患者在骨折切开复位内固定术后均继发创伤性关节炎并逐渐发生髋关节强直,病程21～67个月,平均37.6个月.术中采用股骨颈“V”型截骨去除髋关节融合状态,准确定位髋臼旋转中心,植入生物型全髋关节假体.感染病例在彻底清创基础上先行抗生素骨水泥间隔体植入,再于二期植入生物型全髋关节假体.结果 手术时间90～150 min,平均108 min.术中出血量280～450 ml,平均320 ml.7例原内固定物均完全取出,包括钢板螺钉5例、螺钉1例、股骨髓内钉＋钢板螺钉1例.术后切口均一期愈合.7例均获得随访,随访时间15～48个月,平均32.5个月.Harris髋关节评分由术前平均（48.8＆#177;6.5）分提高至末次随访的（92.6＆#177;5.1）分,差异有统计学意义（t=22.82,P=0.001）.术后3个月X线片示假体表面广泛性骨长入,髋臼杯假体位置良好,髋臼旋转中心未发生改变.大转子截骨固定后骨愈合良好.术后1年X线片示股骨假体柄下沉2例,下沉均＜1.0 mm;异位骨化2例,Brooker分级Ⅰ、Ⅱ级各1例.术中及随访期间无下肢血管及神经损伤、脱位、假体松动、感染等并发症发生.结论 采用股骨颈“V”型截骨可安全、有效地解除髋关节融合状态.通过髋臼旋转中心准确定位、适配的生物型人工髋关节假体并以合理的角度安装及良好的髋周软组织修复重建,可获得一个稳定的具有正常解剖位置的全髋关节.
Objective To investigate the technique and clinical results of total hip arthroplasty in treating post-traumatic hip fusion ankylosis secondary to operation in acetabular combined with femoral head fracture.Methods From October 2009 to January 2015,7 patients （7 hips） with post-traumatic hip fusion ankylosis underwent total hip arthroplasty.There were 6 males and 1 female with an average age of 38 years （range,25-51 years）.There were 4 hips on the left side,3 hips on the right side.Open reduction and internal fixation were performed on all patients.One patient had a postoperative deep infection and 6 patients underwent implant removal.The hip bony fusion ankylosis was developed secondary to post-traumatic arthritis after the surgery of ipsilateral acetabular combined with femoral head facture.The interval between internal fixation and total hip arthroplasty was 37.6 months on average （range,21-67 months）.The hip bony fusion ankylosis was relieved by wedge shape osteotomy at femoral neck level.The cemenfless prostheses were implanted in suitable places based on the accuracy position of acetabular center.One infection case was treated via surgical debridement,removal of all the screws,and antibiotic-loaded cement spacer implantation in the first stage.The cementless prostheses were implanted in the second stage.Results The average operation time and blood loss was 108 min （90-150 min） and 320 ml （280-450 ml） respectively.The internal fixation devices were explanted completely,including plate and screw in 5 cases,only screw in 1 case,intramedullary nail and screw in 1 case.The mean fallow-up period was 32.5 months （range,15-48 months）.The average Harris hip score improved from 48.8＆#177;6.5 points preoperatively to 92.6＆#177;5.1 points post-operatively （t=22.82,P=0.001）.Osseointegration was developed in all of the acetabular and femoral components at 3 months post-operatively.Radiograph analysis showed satisfied position of acetabular cup and no evidence of implant migration or center of rotation change.Stem subsidence （〈1.0 mm） occurred in 2 cases and heterotopic ossification in 2 cases （Brooker type Ⅰ and type Ⅱ in 1 case,respectively） at one year postoperatively.No complication occurred,such as damages of vessels and nerve,dislocation,component loosening or infection.Conclusion The wedge shape osteotomy of femoral neck is a safe and reliable method in treating hip fusion ankylosis.Total hip arthroplasty can be achieved by reconstruction of acetabular center,suitable components implanted in anatomical position and ideal reconstruction of soft tissue around hip.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2016年第19期1213-1221,共9页
Chinese Journal of Orthopaedics
基金
国家自然科学基金（81371983）
甘肃省科技支撑计划（S04671）
关键词
髋臼
股骨头
骨折
关节强直
关节成形术
置换
髋
Acetabulum
Femur head
Fractures,bone
Ankylosis
Arthroplasty,replacement,hip
