老年移位型股骨颈骨折内固定失败后行全髋关节置换术的疗效  

The efficacy of total hip arthroplasty after failed internal fixation of displaced femoral neck fractures in the elderly

作　　者：张文营 张斌青 倘艳锋 ZHANG Wen-ying;ZHANG Bin-qing;TANG Yan-feng(Graduate School,Hunan University of Chinese Medicine,Changsha,Hunan 410208,China;Image Center,Luoyang Orthopedic-Traumatological Hospital of Henan Province,Henan Provincial Orthopedic Hospital,Luoyang,Henan 471000,China)

机构地区：[1]湖南中医药大学研究生院,湖南长沙410208 [2]河南省洛阳正骨医院(河南省骨科医院)影像中心,河南洛阳471000 [3]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

出　　处：《临床骨科杂志》2024年第6期785-788,共4页Journal of Clinical Orthopaedics

基　　金：河南省中医药管理局中医药科学研究专项(编号:2019ZY2082);河南省科技厅科技攻关计划项目(编号:182102310467)。

摘　　要：目的探讨老年移位型股骨颈骨折内固定失败后行全髋关节置换术(THA)的疗效。方法采用THA治疗29例老年移位型股骨颈骨折内固定失败患者。记录手术情况以及术后并发症发生情况、疼痛VAS评分、髋关节Harris评分、SF-36生活质量评分。结果患者均获得随访,时间12~20个月。手术时间72~136(99.52±20.22)min,切口长度8.2~16.4(13.15±2.27)cm,术中出血量220~516(340.83±83.91)ml,术后引流量121~296(193.07±56.12)ml;住院时间11~21(16.41±3.08)d。术后发生6例并发症,其中2例下肢肌间静脉血栓形成,1例谵妄,1例尿潴留,2例假体后脱位,均经对症治疗后治愈。末次随访时,疼痛VAS评分、Harris评分、SF-36评分均较THA术前改善(P<0.01)。结论THA是治疗老年移位型股骨颈骨折内固定失败后的有效措施,可明显改善髋关节功能及患者生活质量;但应预防术后假体脱位,提示术者需要做好术前评估和规划、术中细致操作,患者术后需要规范康复锻炼。Objective To investigate the effect of total hip arthroplasty(THA)after failed internal fixation of displaced femoral neck fracture in the elderly.Methods THA was used to treat the failed internal fixation after displaced femoral neck fracture in 29 elderly patients.The operative conditions and postoperative complications,pain VAS,hip Harris score and SF-36 quality of life score were recorded.Results All patients were followed up for 12~20 months.The operative time was 72~136(99.52±20.22)min,the incision length was 8.2~16.4(13.15±2.27)cm,the intraoperative blood loss was 220~516(340.83±83.91)ml,and the postoperative drainage volume was 121~296(193.07±56.12)ml.The duration of hospitalization was 11~21(16.41±3.08)days.Postoperative complications occurred in 6 cases,including 2 cases of lower extremity intermuscular venous thrombosis,1 case of delirium,1 case of urinary retention,2 cases of prosthesis posterior dislocation,all of which were cured after symptomatic treatment.At the last follow-up,the pain VAS,Harris score and SF-36 score were significantly improved,compared with those before THA(P<0.01).Conclusions THA is an effective measure for treatment of the failure internal fixation of elderly displaced femoral neck fracture,which can significantly improve hip function and quality of life of patients.However,it is necessary to prevent the dislocation of prosthesis after surgery,which suggests that the surgeon should do a good job in preoperative evaluation and planning,intraoperative careful operation,postoperative standard rehabilitation exercise.

关 键 词：移位型股骨颈骨折 全髋关节置换 内固定失败 老年人 

分 类 号：R683.42[医药卫生—骨科学] R687.4[医药卫生—外科学]