合并偏瘫的老年股骨颈骨折全髋关节置换术的早期疗效  

Total hip arthroplasty in treating elderly femoral neck fracture with hemiplegia

作　　者：臧加成[1,2] 王裕民[2] 王敬博[2] 李欣[2] 杨爽[2] 马信龙[2] 

机构地区：[1]天津医科大学骨科临床学院,300070 [2]天津市天津医院创伤骨科,300211

出　　处：《中华骨科杂志》2017年第23期1466-1473,共8页Chinese Journal of Orthopaedics

摘　　要：目的探讨合并偏瘫的老年股骨颈骨折患者采用高限制型防脱位假体全髋关节置换术的临床疗效。方法2015年6月至2017年1月采用CombiCup全髋关节系统的全髋关节置换术治疗43例合并偏瘫的老年股骨颈骨折患者，男15例，女28例；年龄60-84岁，平均（71．5-5．6）岁。左侧20例，右侧23例；GardenⅢ型股骨颈骨折15例，Ⅳ型28例。下肢肌力3级20例，4级19例，5级4例。伤前可独立行走16例，拄拐行走27例。受伤至手术时间2-5d。术前通过模板技术测量预测假体大小及偏心距，根据术中实际测量结果结合术前计划选择假体型号，采用高限制型防脱位假体恢复偏心距，重建外展肌力臂。根据患者骨密度及髓腔形态选择生物型或骨水泥型股骨柄假体。术后即刻通过骨盆x线检查评价假体植入位置和双下肢长度差。术后2周、1个月、2个月、3个月、6个月、1年、2年进行随访，指导功能锻炼，记录并发症情况。末次随访时以Harris评分评价髋关节功能，采用Fugl—Meyer运动功能评价法评价偏瘫肢体功能。结果术后骨盆X线片示假体位置均良好，髋臼外展角平均45．1°±2．3°。双下肢基本等长，双下肢长度差均≤5mm，平均（2．2±0．8）mm。术后随访6-24个月，平均（11．2±3．5）个月。3例于术后第2天发现患肢小腿深静脉血栓，经溶栓后再通。末次随访时Harris髋关节功能评分为77-96分，平均（90．2±3．8）分。Fugl—Meyer评分为83-100分，平均（97．1±2．5）分。15例肌力由术前3级改善为4级，16例由4级改善为5级。随访期间无一例发生假体脱位、感染，未出现假体松动、下沉、假体周围骨溶解。结论对合并偏瘫的Gardenm、Ⅳ型老年股骨颈骨折患者，如患肢肌力3级以上、伤前可离床活动，采用高限制型防脱位假体全髋关节置换术治疗具有脱位率低的优点，偏瘫肢体功能可得到进一步改�Objective To investigate the clinical effects of high restrictive anti-dislocation prosthesis total hip arthroplasty（THA）in treating elderly femoral neck fracture patients with hemiplegia. Methods From June 2015 to January 2017, Forty- three elderly femoral neck fracture patients with hemiplegia were treated with CombiCup THA system. There were 15 males and 28 females with an average age of 71.5±5.6 years （60-84 years）. The left side was involved in 20 cases, while the right side in 23 cases. There were 15 cases with Garden Ⅲ type and 28 cases with type Ⅳ. Lower limb muscle strength grade were 20 cases in grade 3, 19 cases in grade 4, and 5 cases in grade 5. Sixteen cases walked independently before injury, while 27 of them walked with the aid of crutches. The duration between injuries to operation ranged from 2 days to 5 days. The size of the prosthesis and off- set distance were recorded by template technique pre-operation. The appropriate type of prosthesis was selected to restore the off- set and to reconstruct the abductor muscle arm, according to the actual measurement in the operation and the preoperative plan. Based on the bone mineral density and medullary cavity morphology, biological or cemented femoral stern prosthesis was selected. The quality of the implant and the length of both lower limbs were evaluated by pelvic X-ray immediately after operation. The pa- tients were followed-up at 2 weeks, 1 months, 2 months, 3 months, 6 months, 1 and 2 years. Functional exercise guidance and com- plications were recorded at the follow-up duration. At the last follow-up, the hip function and limb function were evaluated accord- ing to the Harris score and Fugl-Meyer motor function assessment respectively. Results Based on pelvic X-ray evaluation after operation, all prosthesis position were favorable with the average angle of acetabular abduction 45.1±2.3 degrees and the length difference of both limbs less than 5 mm （average 2.2±0.8 mm）. The follow-up duration ranged from 6 to 24 months with

关 键 词：股骨颈骨折 偏瘫 老年人 关节成形术 置换 髋 

分 类 号：R687.4[医药卫生—骨科学]