髋关节骨折内固定术后强直的临床状况及再次治疗方案的选择  

The Clinical Status of Hip Ankylosis after Internal Fixation for Hip Fracture and the Second Selection of Retreatment Plan

作　　者：杨益 文俊恩 赵海[1] 温广宇[1] 王隆辉 陈定中 YANG Yi;WEN Junen;ZHAO Hai(The Second Affiliated Hospital of Hainan Medical College,Hainan Haikou 570311,China)

机构地区：[1]海南医学院第二附属医院骨一科,海南海口570311

出　　处：《河北医学》2018年第7期1169-1174,共6页Hebei Medicine

基　　金：海南省自然科学基金;(编号:2017812174)

摘　　要：目的:探究髋关节骨折内固定术后关节强直的临床状况以及再次治疗方案的选择。方法:对82例行髋关节骨折内固定术后并发关节强直的老年患者病历资料进行回顾性分析,根据再次治疗方案的不同将其分为髋关节置换组(50例)和再次内固定组(32例),分析术后发生关节强直的原因以及再次治疗方案的选择,比较两种再次治疗方案的临床疗效及预后。结果:内固定术后出现关节强直的主要原因为螺钉松动、头颈切出造成骨折愈合不良或股骨头坏死。在再次治疗方案的选择上,骨折出现部分愈合的患者以再次内固定为主,骨折不愈合或股骨头坏死的患者则均为人工全髋关节置换。两种再次治疗方案在治疗后各时间点的髋关节功能评分、Barthel评分上比较未见有明显差异,差异不具有统计学意义(P>0.05)。两组患者在术后随访期间均未见下肢深静脉血栓、感染以及假体松动、沉降等并发症出现,两种治疗方案均安全可靠。结论:采用人工全髋关节置换术或再次内固定治疗均能够帮助患者促进骨折愈合、消除关节强直,使髋关节功能尽快恢复。临床上应根据患者的实际情况,选择合适的方案进行再次治疗。Objective:To research the clinical status of hip ankylosis after internal fixation for hip fracture and the selection of retreatment plan.Methods:The medical records of 82 elderly patients with hip ankylosis after fracture fixation were analyzed retrospectively.According to the different treatment plan,they were divided into the hip replacement group(50 cases)and the re internal fixation group(32 cases).Analyzed the causes of postoperative ankylosis and the choice of retreatment regimen,and compared the clinical efficacy and prognosis of the two retreatment regimens.Result:The main causes of ankylosis after internal fixation were screw loosening,head and neck cutting,poor fracture healing or osteonecrosis of the femoral head.In the choice of re treatment plans,most patients were selected partial fracture healed again.The patients with nonunion or necrosis of the femoral head were all selected for total hip replacement.There were no significant differences in the hip function score and barthel score at each time point after treatment in two differcet re treatment plans,and the differences were not statistically significant,the differences were not statistically significant(P>0.05).During the follow-up period,there were no complications such as deep vein thrombosis,infection,loosening and subsidence of the prosthesis,and the two treatments were safe and reliable.Conclusion:Artificial total hip replacement or secondary internal fixation can help patients to promote fracture healing,eliminate joint stiffness,so as to restore hip function as soon as possible.The appropriate treatment should be selected according to the actual situation of the patients.

关 键 词：髋关节骨折内固定术 术后强直 人工全髋关节置换术 再次内固定术治疗 

分 类 号：R687.3[医药卫生—骨科学]