全髋关节置换术治疗成人股骨颈骨折内固定术后FicatⅢ、Ⅳ期股骨头坏死的临床疗效  

Clinical efficacy of total hip arthroplasty for Ficat stageⅢandⅣosteonecrosis of the femoral head after internal fixation of femoral neck fracture in adults

作　　者：马文龙 陈勤 陈柯 王彦金 刘英科 徐铖菡 田可为 范克杰 MA Wenlong;CHEN Qin;CHEN Ke;WANG Yanjin;LIU Yingke;XU Chenghan;TIAN Kewei;FAN Kejie(Hip Surgery Clinic,Luoyang Orthopedic-Traumatological Hospital of Henan Province(Henan Provincial Orthopedic Hospital),Luoyang,Henan 471000,China;Department of Rehabilitation Medicine,Luoyang Hospital of Traditional Chinese Medicine of Henan Province,Luoyang,Henan 471000,China)

机构地区：[1]河南省洛阳正骨医院(河南省骨科医院)髋关节外科诊疗中心,河南洛阳471000 [2]洛阳市中医院康复医学科,河南洛阳471000

出　　处：《安徽医药》2023年第4期728-732,共5页Anhui Medical and Pharmaceutical Journal

基　　金：河南省科技攻关计划项目(182102310467);河南省中医药传承与创新工程(仲景工程)中医药青苗人才第二批培养项目(豫卫中医函〔2021〕16号);河南省中医管理局首批青苗人才培养项目(豫中医科教〔2018〕16号);河南省中医药科学研究专项课题(20-21ZY2253)。

摘　　要：目的比较全髋关节置换术(THA)治疗成人股骨颈骨折螺钉内固定术后Ficat分期Ⅲ、Ⅳ期股骨头坏死(ONFH)和非创伤性Ficat分期Ⅲ、Ⅳ期股骨头坏死(ONFH)的临床疗效。方法回顾分析2017年1月至2019年10月河南省洛阳正骨医院髋关节外科诊疗中心收治的因股骨颈骨折内固定术后ONFH行THA治疗病人28例(创伤组)和因非创伤性ONFH行THA治疗病人36例(非创伤组)。记录并比较两组手术时间、术中出血量、切口长度、术后引流量、住院时间、术后1 d视觉模拟评分(VAS)以及早期并发症发生情况;记录并比较术后各时间点髋关节Harris评分评价髋关节功能。结果病人随访时间14~22个月,平均18.3个月。创伤组手术时间[(108.25±21.57)min比(97.81±17.38)min]、切口长度[(13.5±2.84)cm比(11.6±2.45)cm]、术中出血量[(349.43±85.15)mL比(285.47±104.36)mL]、住院时间[(15.61±4.08)d比(12.86±4.28)d]均多(长)于非创伤组,均差异有统计学意义(P<0.05)。但两者术后并发症发生率和关节功能比较无明显差别。结论与非创伤性ONFH一期THA相比,股骨颈骨折内固定术后ONFH二期THA手术难度和创伤增加。Objective To compare the clinical efficacy of total hip arthroplasty(THA)for Ficat stageⅢandⅣosteonecrosis of the femoral head(ONFH)and nontraumatic Ficat stageⅢandⅣONFH after screw internal fixation of femoral neck fracture in adults.Methods A retrospective analysis of 28 patients admitted to the Hip and Joint Surgery Center of Luoyang Orthopedic-Traumatological Hospital of Henan Province from January 2017 to October 2019 for ONFH after internal fixation of femoral neck fracture treated with THA(traumatic group)and 36 patients treated with THA for nontraumatic ONFH(nontraumatic group)was performed.The operative time,intraoperative bleeding,incision length,postoperative drainage,hospital stay,postoperative 1 d visual analog score(VAS),and early complications were recorded and compared between the two groups;the hip Harris score was recorded and compared at each postoperative time point to evaluate hip function.Results Patients were followed up for 14 to 22 months,with a mean of 18.3 months.The operation time[(108.25±21.57)min vs.(97.81±17.38)min],incision length[(13.5±2.84)cm vs.(11.6±2.45)cm],intraoperative bleeding[(349.43±85.15)mL vs.(285.47±104.36)mL]and hospital stay[(15.61±4.08)d vs.(12.86±4.28)d]were more(longer)than those in the nontraumatic group,and the difference was statistically significant(P<0.05).But there was no significant difference in postoperative complication rates and joint function between the two.Conclusion Compared with nontraumatic ONFH stageⅠTHA,ONFH stageⅡTHA after internal fixation of femoral neck fractures was more difficult and invasive.

关 键 词：关节成形术 置换 髋 手术后并发症 股骨头坏死 Ficat分期 

分 类 号：R687.3[医药卫生—骨科学]