| 何明长,曾祥鑫,陈志达,等.人工全髋关节置换术治疗髋臼骨折术后创伤性关节炎的中远期疗效.骨科,2021,12(1): 56-62. |
| 人工全髋关节置换术治疗髋臼骨折术后创伤性关节炎的中远期疗效 |
| Long-term efficacy of total hip arthroplasty in treating traumatic arthritis after acetabular fracture |
| 投稿时间：2020-03-22 |
| DOI：10.3969/j.issn.1674-8573.2021.01.011 |
| 中文关键词: 髋臼骨折 创伤性关节炎 关节成形术，置换，髋 中远期疗效 |
| 英文关键词: Acetabular fracture Traumatic arthritis Arthroplasty, replacement, hip Long-term efficacy |
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| 中文摘要: |
| 目的 探讨人工全髋关节置换术（total hip arthroplasty，THA）治疗髋臼骨折术后创伤性关节炎的中远期临床疗效。方法 回顾性分析我院2009年7月至2019年5月收治的21例髋臼骨折术后创伤性关节炎病人的临床资料。其中，男14例，女7例；年龄为（42.38±3.42）岁（24~68岁）。后柱和后壁骨折12例，双柱骨折7例，T型骨折2例；合并骨不连3例，骨折畸形愈合6例，异位骨化4例，股骨头半脱位5例，股骨头塌陷3例。骨折初次内固定手术至THA的间隔时间为（27.6±4.5）个月（6~62个月）。收集病人手术前后的髋关节Harris评分，通过X线、CT对假体状态进行影像学评估。结果 手术采取改良的Harding入路6例、髋后侧入路15例。术中需完全取出内固定物4例、部分取出10例、未取出7例。使用生物固定型假体18例、骨水泥固定假体3例。骨缺损采用结构性植骨2例，松质骨颗粒植骨13例。术后发生假体周围感染1例，经二期翻修后治愈；并发坐骨神经损伤1例，经治疗半年后恢复。病人随访8个月~10年，平均6.5年。发生异位骨化3例，因无功能影响而未处理；髋关节Harris评分从术前的（41.95±1.48）分提高至末次随访时的（93.27±3.05）分，差异有统计学意义（t=52.273，P＜0.001）。结论 THA是治疗髋臼骨折内固定术后继发创伤性髋关节炎的有效治疗方法，应该根据内固定的位置、骨缺损的大小和位置，以及手术医生的经验而选择手术入路。术中不影响假体安放的髋臼内固定物可不取出，对预后无影响。 |
| 英文摘要: |
| Objective To investigate the long-term clinical efficacy of total hip arthroplasty (THA) in the treatment of traumatic arthritis after acetabular fracture. Methods From July 2009 to May 2019, 21 patients with traumatic arthritis after acetabular fracture were retrospective analyzed, including 14 males and 7 females with age of 42.38±3.42 years (range 24-68 years). There were 12 cases of posterior column and posterior wall fractures, 7 cases of double column fractures and 2 cases of T fracture. There were 3 cases of nonunion, 6 cases of malunion, 4 cases of heterotopic ossification, 5 cases of femoral head subluxation and 3 cases of femoral head collapse. Fracture critical arthroplasty interval was 27±4.5 months (6-62 months). The Harris score was used to evaluate the hip function of patients before and after operation. The X ray and CT examinations were done for radiographic evaluation of the hip prosthesis. Results Modified Harding approach was used in 6 cases and posterior hip approach in 15 cases. The internal fixator was removed completely in 4 cases, partially in 10 cases and not in 7 cases. There were 18 cases of biological fixation prosthesis and 3 cases of bone cement fixation prosthesis. Structural bone graft was used in 2 cases and cancellous bone graft in 13 cases. The patients were followed up for 8 months to 10 years with an average of 6.5 years. Heterotopic ossification occurred in 3 cases and periprosthetic infection occurred in 1 case, which was cured after secondary revision; and sciatic nerve injury occurred in 1 case, which recovered after half a year of treatment. The Harris score increased from 41.95±1.48 preoperative to 93.27±3.05 at the final follow-up, with the difference being statistically significant (t=52.273, P＜0.001). Conclusion THA is an effective treatment for the traumatic arthritis after acetabular fracture. Surgical approach should be selected according to the location of internal fixation, the size and location of bone defect and the experience of surgeons. The acetabular fixation materials which did not affect the prosthesis were not removed and had no effect on the prognosis. |
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