Ⅰ期全髋关节置换术治疗股骨转子下骨折合并同侧股骨头坏死  

One Stage Total Hip Arthroplasty for Subtrochanteric Femoral Fractures Combined with Ipsilateralavascular Necrosis of the Femoral Head

作　　者：张盘军[1] 王勇[1] 蒋建农[1] 朱和平[1] 沈优 Zhang Panjun;Wang Yong;Jiang Jiannong(Department of Orthopaedics,Yixing People’s Hospital,Yixing 214200,China)

机构地区：[1]江苏大学附属宜兴医院骨科,江苏宜兴214200

出　　处：《实用骨科杂志》2020年第9期778-781,共4页Journal of Practical Orthopaedics

摘　　要：目的探讨Ⅰ期全髋关节置换术治疗股骨转子下骨折合并同侧股骨头坏死的手术方法及其临床疗效。方法我院自2009年6月至2018年5月收治7例股骨转子下骨折合并同侧股骨头坏死患者。其中男5例,女2例;年龄56~79岁,平均(67.58±7.89)岁。股骨转子下骨折按照Seinsheimer分类,ⅡB型5例,ⅢA型2例。股骨头坏死按照Ficat分期均为Ⅳ期。所有患者均采取生物型全涂层股骨长柄假体行Ⅰ期全髋关节置换术。结果术中无一例出现股骨穿孔、股骨骨折等并发症。手术时间为(111.00±29.18)min;术中失血量为(465.00±150.45)mL。所有患者获得随访,随访时间为(32.00±13.56)个月。末次随访时所有患者均能独立下地行走。Harris评分为(89.00±8.28)分,其中优5例,良1例,可1例,优良率为85.71%。骨折均获得愈合,愈合时间为(4.30±1.03)个月。髋臼杯和股骨柄假体均获得骨性稳定。随访期间无感染、下肢深静脉血栓形成、脱位和假体松动等并发症发生。结论Ⅰ期全髋关节置换术治疗股骨转子下骨折合并同侧股骨头坏死可以获得满意的临床疗效。生物型全涂层股骨长柄假体初始稳定性好,为骨折愈合提供了良好的髓内环境从而有利于骨折愈合,是治疗此类损伤的理想选择。Objective To evaluate the clinical and radiological results of one stagetotal hip arthroplasty(THA)in the treatment ofsubtrochanteric femoral fractures combined with ipsilateral avascular necrosis of the femoral head.Methods From June 2009 to May 2018,7 patients(7 hips)with subtrochanteric femoral fractures combined with ipsilateral avascular necrosis of the femoral head were treated by one stage THA using an uncemented fully porous-coated long femoral stem prosthesis in our department.There were five males and two females,with an average age of(67.58±7.89)years old.According to the Seinsheimer's classification,there was 5 typeⅡB,2 typeⅢA.According to the Ficat's classification,they were all typeⅣ.Results here were no intra-operative complications such as femoral perforations and femoral fractures.The operation time for this serieswas(111.00±29.18)min.The intraoperative blood loss was(465.00±150.45)mL.All the patients were followed up,the follow-up time was(32.00±13.56)months.At last follow-up,all patients were able to walk independently.The HHS scorewas(89.00±8.28).And according to the HHS score,it wasexcellent in 5 patients,good in 1patients,and fair in 1 patients,andthe good and excellent ratings was 85.71%.All fractures got bone union with average union time(4.30±1.03)months.All the acetablar and femoral stem showed stable prosthesis.There were no infection,deep vein thrombosis,dislocation and aspetic loosening.Conclusion One stage THA in the treatment ofsubtrochanteric femoral fractures combined with ipsilateral avascular necrosis of the femoral head can provide a single operation that both stabilized the fracture and eliminated hip disease.An uncemented fully porous-coated long femoral stemsprovides a good intramedullary fracture stability that promotes fracture healing.

关 键 词：转子下骨折 股骨头坏死 髋关节置换 

分 类 号：R683.42[医药卫生—骨科学]