生物型全髋关节置换术治疗伴下肢短缩陈旧性股骨颈骨折的研究  

Cementless total hip arthroplasty treats old femoral neck fractures with lower limb discrepancy

作　　者：李旭升[1] 周胜虎[1] 甄平[1] 高明暄[1] 田琦[1] 常彦峰[1] 李生贵[1] 

机构地区：[1]兰州军区兰州总医院骨科研究所关节外科,730050

出　　处：《中华关节外科杂志（电子版）》2015年第3期33-36,共4页Chinese Journal of Joint Surgery(Electronic Edition)

基　　金：甘肃省科技计划项目(1208RJZA108);兰州军区课题(CLZ12JAO7)

摘　　要：目的探讨生物型髋关节置换治疗陈旧性股骨颈骨折伴有下肢短缩的临床疗效。方法2007年9月至2012年9月,对52例陈旧性股骨颈骨折患者实施生物型全髋关节置换,其中男28例,女24例,平均年龄59.5岁（47~82岁）,其中股骨颈骨折后经保守治疗（19例）,内固定治疗（33例）。术前拍摄髋关节正侧位X线及CT,测量髋关节偏心距、旋转中心、髋臼值和股骨假体大小、颈长和截骨位置;术后1、3、6个月、1年及以后每年均复查并拍X线片了解假体位置及骨长入状况,采用Harris评分评估术后患髋功能恢复情况。结果术后患者均获得随访,平均时间3.5年（6~54个月）,无死亡病例,发生深静脉血栓2例,无术后关节脱位及坐骨神经损伤,无假体周围骨折,无假体松动、断裂等并发症。术前Harris评分（38.5±2.3）分,术后（92.7±4.1）分,差异有统计学意义（P〈0.05）。两侧肢体长度差：术前1.5~4.5 cm,术后0.5~1.0 cm。术前髋关节总活动度（屈伸、内收、外展、内外旋）为（43.7±4.6）°,术后为（192.3±5.7）°。术后48例患者髋关节无疼痛,3例患者为轻度疼痛,1例患者大腿外侧及膝关节疼痛,无需药物止痛,日常生活无影响。结论生物型髋关节假体能有效治疗陈旧性股骨颈骨折,恢复下肢长度及髋关节功能,缓解疼痛,提高生活质量,疗效满意。Objective To investigate the clinical efficacy of cementless hip arthroplasty in the treatment of old femoral neck fractures with lower limb shortening. Methods From September 2007 to September 2012,52 cases of old femoral neck fractures underwent cementless total hip arthroplasty,including 28 males and 24 females,with an average age of 59. 5 years（ 47 to 82 years）. Among the patients,19 cases adopted the conservative treatment after the fracture,and 33 cases accepted the internal fixation. Preoperative anterior-posterior and lateral radiographs as well as CT scans of the hip were performed,in order to measure the hip offset, rotation center, the size of acetabulum and femoral prosthesis,femoral neck length and the position of bone cutting. The recovery of joint functions was evaluated by Harris score; X ray images were taken in the postoperative 1st,3rd,6thmonth,one year,and every year afterwards to observe the prosthesis position and osseointegration. Results The patients were followed up for an average period of 3. 5 years（ 6- 54 months） without death case; two cases of deep vein thrombosis were observed. No postoperative dislocation,sciatic nerve injury,periprosthetic fractures,prosthesis loosening,implant fracture or other complications were found. The preoperative Harris hip score was（ 38. 5 ± 2. 3）,and the postoperative one was（ 92. 7 ± 4. 1）; the difference was statistically significant（ P〈 0. 05）. The length discrepancy of the lower limbs was 1. 5- 4. 5 cm preoperatively and 0. 5- 1. 0 cm postoperatively. The range of motion of the hip（ flexion,adduction,abduction,external rotation） was（ 43. 7 ± 4. 6） ° preoperatively,（ 192. 3 ± 5. 7） ° postoperatively. Forty- eight patients were pain-free after the operation,three patients complained mild pain,and one patient complained pain in the lateral thigh and knee. All of the patients＇ complaining about pain did not need analgesic drugs,for the pain did not affect their daily lives. Conclusion Cementless hip prosthesis ca

关 键 词：关节成形术 置换 髋 股骨颈骨折 

分 类 号：R687.3[医药卫生—骨科学]