陈旧性髋臼骨折合并股骨头坏死的全髋关节置换术中髋臼重建策略  

Acetabular reconstruction strategy in total hip replacement for old acetabular fractures complicated with femoral head necrosis

作　　者：乐国平[1] 张明[1] 杨成志[1] 方怀玺[1] 王勇[1] 周定球[1] 郑健伟 温日有 LE Guo-ping;ZHANG Ming;YANG Cheng-zhi;FANG Huai-xi;WANG Yong;ZHOU Ding-qiu;ZHENG Jian-wei;WENG Ri-you(Osteopathic joint surgery,the Fourth Affiliated Hospital of Guangxi Medical University,Liuzhou,Guangxi 545005,China)

机构地区：[1]广西医科大学第四附属医院骨病关节外科

出　　处：《中国骨与关节损伤杂志》2019年第6期561-563,共3页Chinese Journal of Bone and Joint Injury

基　　金：广西壮族自治区卫计委自筹经费科研课题(Z20180512)

摘　　要：目的探讨采用全髋关节置换术治疗陈旧性髋臼骨折合并股骨头坏死术中髋臼处理的方法以及中期临床疗效。方法选取自2013-05—2017-06收治陈旧性髋臼骨折合并股骨头坏死15例,术前充分评估髋臼骨质缺损情况,必要时术前辅助3D打印,一期在全身麻醉下进行人工全髋关节置换术。结果15例均获得随访,随访时间平均35(12~48)个月,所有手术均顺利完成。术后12个月Harris评分(89±6.8)分,与术前的(35±3.5)分比较明显改善,差异有统计学意义(t=4.20,P<0.05)。髋关节功能得到明显改善,没有出现关节感染、关节假体松动脱位、神经损伤等重大并发症。结论采用全髋关节置术治疗陈旧性髋臼骨折合并股骨头坏死的临床中期疗效满意,可早期恢复关节功能锻炼,可明显改善继发性骨性关节炎所致的病残率,但术前一定要充分准备,根据髋臼缺损情况采用不同的处理策略。Objective To explore the method of acetabular reconstruction in the treatment of old acetabular fractures complicated with femoral head necrosis by total hip arthroplasty and its mid-term clinical effect. Methods Fifteen cases of old acetabular fractures and femoral head necrosis were treated in our hospital from May 2013 to June 2017. The acetabular bone defects were fully evaluated before operation. If necessary, assisted 3D printing was used before operation. Artificial total hip arthroplasty was performed under general anesthesia. Results All 15 patients underwent successful operation. The preoperative Harris score was (35±3.5), and the Harris score 12 months after operation was (89±6.8). Follow-up was 12-48 months, average 35 months. The hip function was significantly improved (t =4.20, P <0.05). There were no major complications such as joint infection, joint prosthesis loosening and dislocation, and nerve injury. Conclusion Total hip arthroplasty is satisfactory in the treatment of old acetabular fractures with femoral head necrosis. It can restore the joint function of the early stage and can significantly improve the morbidity caused by osteoarthritis. However, it must be fully prepared before surgery, and different treatment strategies should be adopted according to the acetabular defect.

关 键 词：股骨头坏死 髋臼骨折 全髋关节置换术 

分 类 号：R687.3[医药卫生—骨科学]