偏瘫侧股骨颈骨折应用双动全髋关节假体的疗效分析  

Dual mobility total hip arthroplasty for the treatment of femoral neck fracture with hemiplegia

作　　者：王晓东[1] 魏杰[1] 郭秀生[1] 曹鑫杰 刘建友 WANG Xiao-dong;WEI Jie;GUO Xiu-sheng;CAO Xin-jie;LIU Jian-you(不详;Department of Orthopaedics,People's Hospital of Shanxi Province,Taiyuan 030053,Shanxi,China)

机构地区：[1]山西省人民医院骨科,山西太原030053 [2]山西医科大学研究生院,山西太原030001

出　　处：《中国骨伤》2020年第9期801-806,共6页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨双动全髋关节假体在偏瘫侧股骨颈骨折的临床疗效。方法:回顾性分析2014年3月至2016年12月使用双动全髋关节假体对偏瘫侧股骨颈骨折行初次髋关节置换术并有完整随访资料的18例患者,男5例,女13例;年龄65~70(66.50±1.38)岁;左侧12例,右侧6例;股骨颈骨折GardenⅢ型4例,Ⅳ型14例。偏瘫侧肢体肌力Ⅳ级。均采用髋关节后外侧入路,双动全髋关节假体。通过X线检查评价假体植入位置、假体脱位及假体松动。采用Harris髋关节评分和Merle D'aubigne髋关节评分进行髋关节功能评估。结果:手术时间70~90(81.56±7.48)min。出血量160~200(170.32±12.56)ml。术中均未输血,术后切口均Ⅰ期愈合。随访时间28~60(36.0±3.5)个月。Harris髋关节评分由术前的16.94±0.73提高到末次随访时的96.19±1.27(P<0.05)。Merle D'Aubigne评分由术前的3.96±0.06提高到末次随访时的16.81±0.63(P<0.05)。术中未发生骨折及神经、血管损伤。术后X线片显示假体位置良好。术后及随访期间无关节脱位、假体内脱位、假体松动、假体周围骨折、大腿前方疼痛、髂骨处自攻螺钉断裂及迟发感染等并发症发生。结论:双动全髋关节假体具有良好的初始稳定性及假体脱位率低的优点,在偏瘫侧股骨颈骨折的全髋关节置换术中临床应用疗效满意。Objective:To investigate the clinical effects of dual mobility total hip prosthesis in treating femoral neck fracture patients with hemiplegia.Methods:A retrospective analysis was performed on 18 patients with femoral neck fracture combined with hemiplegia who underwent dual mobility total hip prosthesis replacement from March 2014 to December 2016.The follow-up data of these patients was complete.There were 5 males and 13 females,aged 65 to 70 years old with an average of(66.50±1.38)years.The left side was involved in 12 cases,while the right side in 6 cases.There were 4 cases with GardenⅢtype and 14 cases with typeⅣ.Limb muscle strength of hemiplegia were in gradeⅣ.The posterior-lateral approach of hip joint was used in surgery for all patients.The implant position,dislocation and loosening of the prosthesis were evaluated by X-ray examination.Harris hip score and the Merle D'aubigne score were used to assess the hip function in the follow-up.Results:The operation duration was for 70-90(81.56±7.48)min and the blood loss during the operation was for 160-200(170.32±12.56)ml.No blood was transfused during the operation.Postoperative incisions were healed at the first stage.The follow-up time was for 28-60(36.0±3.5)months.Harris hip score increased from 16.94±0.73 preoperatively to 96.19±1.27 at the final follow-up(P<0.05).Merle D’Aubigne score increased from 3.96±0.06 preoperatively to 16.81±0.63 at the final follow-up(P<0.05).No fracture or nerve or vascular injury were found during the operation.The postoperative X-ray showed that the prosthesis was in good position.No complications such as joint dislocation,dislocation of prosthesis,loosening of prosthesis,fracture around the prosthesis,pain in the front of the thigh,fracture of the self-tapping screw in the ilium,and delayed infection occurred in the patients after operation.Conclusion:Dual mobility total hip prosthesis has the advantages of both good initial stability and low dislocation rate of the prosthesis,and the clinical application of t

关 键 词：股骨颈骨折 偏瘫 关节成形术 置换 髋 

分 类 号：R683[医药卫生—骨科学]