挽救性髋关节置换术治疗髋部骨折术后内固定物失效的临床效果  

Clinical effect of salvage hip arthroplasty in treatment of internal fixation failure after hip fracture surgery

作　　者：许张民 康健 刘智深 田少斌 王一雄 刘建斌 张辉 李永涛 XU Zhangmin;KANG Jian;LIU Zhishen;TIAN Shaobin;WANG Yixiong;LIU Jianbin;ZHANG Hui;LI Yongtao(Orthopedic Trauma Department of Jincheng General Hospital,Jincheng,Shanxi 048006,China)

机构地区：[1]晋城大医院创伤骨科,山西晋城048006

出　　处：《中国骨与关节损伤杂志》2024年第12期1239-1247,共9页Chinese Journal of Bone and Joint Injury

摘　　要：目的 观察挽救性髋关节置换术治疗髋部骨折术后内固定物失效的临床效果。方法 回顾性分析自2014-02—2023-10采用人工髋关节置换术治疗的33例髋部骨折内固定术后失效患者。根据术后随访X线片评价股骨侧及髋臼侧假体位置、角度、大小、稳定性及肢体长度差异,并记录疼痛VAS评分、髋关节功能Harris评分;观察假体骨长入情况,明确股骨假体周围7个区和髋臼周围3个区的透亮带宽度是否超过2 mm,是否超过总长度的50%;明确是否存在假体移位下沉、骨溶解、异位骨化、继发性骨折等并发症,必要时进行相关化验检查以排除感染。结果 所有患者均获得随访,随访时间1~9年,平均4.2年。末次随访时,除1例平素因脑梗死后遗症长期卧床外,其余患者步态基本正常,所有患者双下肢基本等长,疼痛症状及关节功能障碍均较术前明显改善,随访过程中均未出现髋关节脱位、假体松动、假体周围感染等并发症。术后1年、末次随访疼痛VAS评分均较术前显著降低,差异有统计学意义(F=279.879,P<0.001),提示患者髋关节疼痛明显缓解。术后1年、末次随访髋关节功能Harris评分均较术前显著增加,差异有统计学意义(F=269.628,P<0.001),提示患者髋关节功能得到了明显改善。末次随访时患者双下肢长度差异(0.04±0.12)cm,较术前(1.12±0.28)cm明显变小,差异有统计学意义(t=27.849,P<0.001)。结论 采用髋关节置换手术治疗髋部骨折内固定术后失效的临床效果良好,术后疼痛症状、髋关节功能改善明显。Objective To observe the clinical effect of salvage hip arthroplasty in the treatment of internal fixation failure after hip fracture surgery.Methods A retrospective analysis was performed on 33 patients with artificial hip arthroplasty for internal fixation failure after for hip fracture operation from February 2014 to October 2023 was conducted.The position,angle,size,stability of the femoral and acetabular prosthesis,and limb length difference were evaluated according to the follow-up X-ray films.The VAS score of pain and Harris score of hip joint function were also recorded.The bone ingrowth of the prosthesis was observed by determining whether the width of the radiolucent lines in 7 zones around the femoral prosthesis and 3 zones around the acetabular prosthesis exceeded 2 mm and 50% of the total length.Whether there were complications such as prosthesis displacement and subsidence,osteolysis,heterotopic ossification,and secondary fracture were determined,and relevant laboratory tests were performed to rule out infection when necessary.Results All patients were followed up for an average of 4.2 years(1-9 years).At the last follow-up,except for 1 patient who was bed-bound due to the sequela of cerebral infarction,the gait of the other patients was generally normal,and the lower limbs of all patients were nearly equal in length.The pain symptoms and joint dysfunction were significantly improved when compared with those before surgery,and there were no complications such as hip dislocation,prosthesis loosening and periprosthesis infection during follow-up.Compared with the preoperative results,the pain VAS score was significantly decreased at 1 year postoperative and the last follow-up,and the difference was statistically significant(F=279.879,P<0.001),indicating that the patient's hip pain was significantly relieved.Compared with before surgery,the Harris score of hip function was significantly increased at 1 year post surgery and the last follow-up,and the difference was statistically significant(F=269.628,P<

关 键 词：髋部骨折 髋关节置换 翻修术 内固定失效 

分 类 号：R687.4[医药卫生—骨科学]