关节置换联合内固定治疗股骨头坏死伴粗隆间骨折疗效分析  

Curative effect analysis of arthroplasty combined with internal fixation for the treatment of femoral head necrosis with intertrochanteric fractures

作　　者：韩文锋[1] 刘欣伟[1] 孙保飞 何勇[1] 郭超[1,2] 张旭腾 张敬东[1] HAN Wen-feng LIU Xin-wei SUN Bao-fei HE Yong GUO Chao ZHANG Xu-teng ZHANG Jing-dong(Department of Orthopaedics, General Hospital of Shenyang Military, Shenyang Liaoning 110016, China Jinzhou Medical University, Jinzhou Liaoning 121002,China)

机构地区：[1]沈阳军区总医院骨科,辽宁沈阳110016 [2]锦州医科大学,辽宁锦州121002

出　　处：《局解手术学杂志》2017年第6期423-427,共5页Journal of Regional Anatomy and Operative Surgery

基　　金：辽宁省科学技术计划项目面上项目(2015020446)

摘　　要：目的探讨大粗隆钢板辅助全髋关节置换术治疗同侧股骨粗隆间骨折合并股骨头坏死的近期临床疗效。方法回顾性分析2011年1月至2014年6月沈阳军区总医院骨科收治的28例同侧股骨粗隆间骨折合并股骨头坏死患者的临床资料,所有患者均采用切开复位大粗隆钢板固定联合全髋关节置换术治疗;记录手术时间、出血量、大粗隆骨折骨性愈合时间、术后并发症,有无内固定装置松动、感染发生率,同时对术前术后髋关节Harris评分进行统计学分析。结果平均手术时间(174.0±27.1)min,平均出血量(530.0±132.0)mL。2例患者术后发生下肢深静脉血栓,其余病例无严重并发症发生。所有患者均有完整随访资料,随访时间12~24个月,平均(16.3±7.0)个月。28例患者大粗隆均骨性愈合,平均愈合时间(5.0±1.5)个月。术前Harris评分(28.0±7.1)分,术后Harris评分(86.5±5.3)分,术前术后比较差异具有统计学意义(t=-21.699,P=0.000)。至随访结束,无内固定装置松动,无线缆断裂,无感染病例。结论大粗隆钢板辅助全髋关节置换术治疗同侧股骨粗隆间骨折合并股骨头坏死固定可靠,假体初期稳定性好,关节功能恢复好;能同时维持骨折端稳定和早期恢复关节功能,使股骨粗隆间骨折和股骨头坏死得到同期治疗,其近期临床疗效满意。Objective To analyze the short-term clinical efficacy of the treatment of ipsilateral femoral intertrochanteric fractures with femoral head necrosis through total hip arthroplasty combined with internal fixation. Methods From January 2011 to June 2014 a total of 28 cases of ipsilateral femoral intertrochanteric fractures with femoral head necrosis were selected, and they were all treated with open reduction and greater trochanter plate fixation combined with total hip arthroplasty. The time of operation, amount of bleeding, time of bone healing of the greater trochanteric fracture, postoperative complications, rate of internal fixation device loosening, incidence of infection, and the Harris score of the hip joint before and after operation were recorded and statistically analyzed. Results The mean operative time was （ 174.0 ± 27.1 ） min and the mean blood loss was （530.0 ± 132.0） mL. There were 2 cases of deep venous thrombosis in the lower extremi- ties, and there was no serious complications occured among the remaining cases. All patients were followed up for 12 to 24 months, averagely （ 16.3 ±7.0） months. All the 28 patients get bony union of the large trochanter,with the average healing time of （5.0 ± 1.5） months. The preoperative Harris score was （28.0 ± 7.1 ） points, while it was （ 86.5 ± 5.3 ） points after the surgery, and the difference was statistically significant （ t = - 21. 699, P = 0.000 ）. At the end of the follow-up, there was no internal fixation device loosening, no cable breakage, and no infection cases. Conclusion Total hip arthroplasty combined with internal fixation for the treatment of ipsilateral femoral intertrochanteric fractures with femoral head necrosis, especially the large trochanteric fractures, were of reliable fracture fixation, good initial stability and good joint function recovery. And it can maintain fracture stability and early recovery of joint function, so that intertrochanteric fractures and femoral head necrosis were treated simultaneous

关 键 词：关节置换 内固定 骨折 股骨头坏死 股骨粗隆间骨折 切开复位 

分 类 号：R687.4[医药卫生—骨科学]