人工髋关节置换术治疗髋部骨折内固定失败的临床研究  

Clinical study of hip arthroplasty after failed internal fixation of hip fractures

作　　者：冯明利[1] 沈惠良[1] 曹光磊[1] 李征[1] 王宝宝[1] 武京伟[1] 黄江[1] 

机构地区：[1]首都医科大学宣武医院骨科,北京市100053

出　　处：《中国骨与关节损伤杂志》2014年第2期121-123,共3页Chinese Journal of Bone and Joint Injury

基　　金：北京市科技计划项目(D121100004212004)

摘　　要：目的探讨应用人工髋关节置换术治疗髋部骨折内固定失败时假体的选择及术后疗效。方法回顾性分析自2008—01—2011-06应用人工髋关节置换术治疗的髋部骨折内固定失败28例，其中股骨颈骨折内固定失败15例。股骨粗隆间骨折内固定失败13例。再次手术中，全髋关节置换19例，双极人工股骨头置换9例。选用骨水泥型假体柄11例，其中加长柄4例；生物型假体17例，其中加长柄7例。随访并记录存活患者术后6个月时的髋关节功能Harris评分，并与术前评分进行比较。结果1例围手术期因肺部感染死亡。1例术后3个月因心肌梗死而死亡。其他26例随访6～32个月，平均18个月。术后6个月髋关节功能Harris评分平均86分，其中优10例，良12例，可3例，差1例，优良率84．6％。术后6个月髋关节功能Harris评分平均86分，较术前平均42分明显提高，差异有统计学意义（P=0．001）。结论人工髋关节置换术是治疗髋部骨折内固定失败的有效方法，选用股骨加长柄行人工髋关节置换术治疗股骨粗隆间骨折内固定失败疗效可靠。Objective To explore the curative effect of hip arthroplasty after failed internal fixation of hip fractures and how to select prosthesis. Methods Between January 2008 and June 2011, 28 patients with failed internal fixation of hip fractures were treated with hip arthroplasty. There were 15 cases and 13 cases in internal fixation failure of femoral neck fracture and femoral intearochanteric fractures, respectively, in these canversion procedures for this group of patients, 19 total hip arthroplasty and 9 hemiarthroplasty were performed. In the total cases, there were 11 cemented prosthesis and 17 uncemented prosthesis, including 4 cemented long-stem and 7 uncemented long-stem, respectively. Follow-up was remained for 6 months at least or until death. Harris hip score was recorded before operation and 6 months after reoperation. Results One patient died from pulmonary infection during perioperative period （cemented prosthesis）, and another one died from myocardial infarction at 3 months after reoperation（uncemented prosthesis）. The others were followed-up for 6 to 32 months, there were no prosthetic dislocation and infection. Harris hip score was 42 points before operation and 86 points at 6 months after reoperation. By Har,is hip score, 10 patients were rated as excellent, 12 as good, 3 as fair, 1 as poor, with excellent and good rate of 84.6%. There was a significant differences in Harris hip scores before operation and 6 months after reoperation by T- examination （P =0.001）. Conclusion Hip arthroplasty is an effective treatment after failed internal fixation of hip fractures, and hip arthroplasty with long-stem prosthesis is a reliable treatment for failed internal fixation of femoral intertroehanteric fractures.

关 键 词：髋部骨折 内固定失败 人工髋关节置换术 骨水泥型假体 生物型假体 股骨加长柄 

分 类 号：R687.3[医药卫生—骨科学]