全髋关节置换术治疗髋臼骨折初期治疗失败病例的中期随访结果  

Total hip arthroplasty for failed treatments of acetabular fractures: midterm follow-up result

作　　者：蒋毅[1] 张亮[1] 周一新[1] 

机构地区：[1]北京积水潭医院矫形骨科,北京100035

出　　处：《中国骨与关节外科》2015年第1期32-37,共6页Chinese Journal of Bone and Joint Surgery

摘　　要：背景背景：髋臼骨折常见于高能量的暴力损伤,即使经过初期有效治疗仍可能在后期出现髋关节骨关节炎、股骨头缺血性坏死以及坐骨神经损伤等并发症而需要进一步治疗。目的：回顾性分析全髋关节置换术（THA）治疗髋臼骨折初期治疗失败病例的中期临床和影像学随访结果。方法方法：1998年9月至2011年8月行THA治疗髋臼骨折初期治疗失败患者108例（110髋）,其中96例（98髋）获得随访,随访时间26-146个月,平均54.2个月。比较其中51例既往采用切开复位内固定治疗和47例既往采用保守治疗患者所行THA的疗效差异。采用Harris髋关节评分系统进行临床评价,依据术后X线片进行影像学分析。结果结果：髋关节Harris评分从术前平均46.3分（14~78分）提高至末次随访的平均91.4分（56-100分）（P〈0.001）。并发症包括术中股骨矩骨折4例、脱位1例、医源性坐骨神经损伤4例、假体周围感染2例及BrookerⅢ级异位骨化3例。仅有1例患者因全骨水泥型假体无菌性松动行翻修术。结论结论：采用THA治疗髋臼骨折初期治疗失败病例的中期临床和影像学结果较为满意,具有较高的假体生存率和患者满意度,但在技术上存在诸多难点,围手术期管理和手术细节等方面需要特别注意。Background： Fractures of the acetabulum usually results from high-energy injuries with the potential for a poor outcome regardless of initial treatment method. Complications may include post-traumatic arthritis, osteonecrosis of the femoral head and sciatic nerve injury.Objective： To evaluate midterm clinical and radiographic results of total hip arthroplasty for failed treatments of acetabular fractures.Methods： A total of 108 patients（110 hips） undergoing total hip arthroplasty for failed treatments of acetabular fractures between September 1998 and August 2011 were retrospectively reviewed in our institution. Among them, 96 patients（98 hips）were followed up for 54.2 months on average（range, 26-146 months） and enrolled in the study. The clinical outcomes of arthroplasty were compared between 51 patients treated initially with open reduction and internal fixation and 47 patients with non- operative treatments for acetabular fracture. Clinical results were evaluated by Harris Hip Score and radiographic results were analyzed by postoperative serial X-ray films.Results： The average Harris Hip Score increased from preoperative 46.3（range, 14-78） to 91.4（range, 56-100） at the last follow-up（P0.001）. Intraoperative calcar fractures occurred in 4 cases, dislocation in 1, sciatic nerve injuries in 4, periprosthetic infections in 2 and heterotopic ossification（level Ⅲ） in 3. There was only one revision due to aseptic loosening of cemented acetabular and femoral component.Conclusions： Although the technically demanding nature of the procedure, the results of total hip arthroplasties in patients with failed treatments for acetabular fractures are encouraging with high prosthesis survivorship and patients＇ satisfaction. The surgeons should pay careful attention to all possible risk factors perioperatively and develop a comprehensive treatment regimen.

关 键 词：关节置换术 髋关节 髋臼骨折 

分 类 号：R687.4[医药卫生—骨科学]