股骨近段髓腔重建双动股骨头置换术  

Reconstruction of proximal femoral medullary cavity in bipolar femoral head replacement for osteoporotic femo-ral neck fractures in the elderly

作　　者：谷增泉 蔺伟 王石磊 王加利 宋振 李瑞欣 董长军 GU Zeng-quan;LIN Wei;WANG Shi-lei;WANG Jia-li;SONG Zhen;LI Rui-xin;DONG Chang-jun(Department of Orthopaedics,Jinan People's Hospital Affiliated to Shandong First Medical University,Jinan 271199,China)

机构地区：[1]山东第一医科大学附属济南人民医院济南市人民医院,山东济南271199

出　　处：《中国矫形外科杂志》2020年第8期747-750,共4页Orthopedic Journal of China

摘　　要：[目的]介绍股骨近段髓腔重建双动股骨头置换术治疗高龄骨质疏松股骨颈骨折的手术技术和初步临床效果。[方法] 2015年3月~2019年6月,对92例高龄骨质疏松性股骨颈骨折患者行双动股骨头置换术。经Harding入路显露股骨近端,PFNA主钉作为髓腔中置器,利用自体股骨头碎骨进行颗粒打压植骨,重建股骨近段髓腔,置入相适应的生物型假体柄,完成股骨柄假体置换的生物学固定。[结果] 92例患者均顺利手术,随访8~48个月,获得随访患者80例,3例因摔伤导致假体周围骨折松动,再次行内固定手术。77例患者均愈合良好,无松动,无感染,末次Harris评分(87.93±17.59)分,优良率为84.42%(65/77)。假体下沉2例,骨溶解1例,重度应力遮挡1例。[结论]利用取出的股骨头骨颗粒结合PFNA主钉再造股骨近段髓腔,压配成形,采用常规号生物柄假体完成髋关节置换,该方法对老年骨质疏松股骨颈骨折患者,安全有效,经济实用。[Objective] To introduce the surgical technique and primary clinical outcomes of bipolar femoral head replacement subsequent to reconstruction of proximal femoral medullary cavity for osteoporotic femoral neck fractures in the elderly.[Methods] From March 2015 to June 2019, 92 elderly patients underwent bipolar femoral head replacement for osteoporotic femoral neck fractures. After exposure of the proximal femoral end through Harding approach, a main nail of proximal femoral nail anti-rotation(PFNA) was inserted into the intramedullary cavity as the centralizer, and granular bone autografts made of the femoral head were filled into the cavity and impacted tightly to reconstruct the proximal femur. Finally, a stem component in suitable size was inserted into the proximal intramedullary cavity, and firmly fixed by press-fit. [Results] All the 92 patients underwent femoral head replacement smoothly, and 80 patients of them were followed up for 8-48 months. During the follow up period, 3 patients suffered from periprosthetic fracture due to falling, and then received internal fixation surgery again, in contrast,the remaining 77 patients recovered well. At the latest follow up, the Harris score was of(87.93±17.59), correspondingly, the excellent and good rate of clinical outcomes was 84.42%(65/77). Regarding to imaging, no prosthetic loosening was found except prosthesis subsided in 2, osteolysis in 1 and severe stress shielding in 1 case. [Conclusion] This bipolar hemiarthroplasty, with reconstruction of proximal femoral medullary cavity by femoral head granular bone autograft impacted using PFNA nail as centralizer for press-fit fixation of stem component, is safe and high cost efficient technique for osteoporotic femoral neck fractures in the elderly.

关 键 词：骨质疏松性股骨颈骨折 老年人 股骨近段骨髓腔成形 双动股骨头置换术 

分 类 号：R683.42[医药卫生—骨科学]