摘要
目的探讨股骨转子间骨折及股骨颈骨折复位内固定失败后全髋关节置换术临床疗效及影响因素。方法自1998年8月至2009年3月,本组收治股骨转子间骨折及股骨颈骨折复位内固定失败患者21例,其中男11例,女10例,年龄37～87岁,平均66.3岁。其中股骨颈骨折12例,股骨转子间骨折9例。内固定种类:动力髋螺钉(DHS)5例,动力髁螺钉(DCS)2例,股骨近端髓内钉(PFN)1例,伽马钉2例,Hansson针1例,合并股骨上段粉碎性骨折行交锁钉内固定1例,空心钉9例。失败原因:股骨头坏死7例,骨折不愈合7例,不愈合合并股骨头坏死2例,钉松脱、切割致骨折移位或不愈合5例。以上21例内固定失败后致患肢缩短19例。置换术使用的皆为标准假体,无应用加长柄,无应力性骨折病例。假体类型:生物型6例,全骨水泥型4例,混合型11例。就术前术后功能改善、肢体长度恢复、手术并发症等进行评估,并分析其与患者年龄,两次手术间隔时间、术前肢体缩短畸形程度等因素间关系。结果无住院死亡患者。随访中,4例死于系统性疾病。Harris评分由全髋关节置换术前(27.53±2.96)分提高到置换术后最后一次随访(80.76±4.25)分。术前患肢缩短(2.67±1.06)cm,术后改善致(0.85±0.88)cm。患者年龄越轻,内固定失败后再次手术时间间隔越长,肢体缩短更严重,术中肢体长度的恢复也更困难。并发症:术后创伤性精神障碍1例,治疗后好转;术后脱位1例,麻醉下手法复位,外展支具固定6周;术中股骨上段劈裂骨折1例,无特殊处理。松动1例,翻修术后2年死于脑血管意外。结论全髋关节置换术是髋部骨折内固定失败后有效的补救措施,宜尽早手术、并需因应病例个体病理改变情况,而相应作综合评估、考虑。
Objective To evaluate clinical effects and the influence factors of total hip arthroplasty after reduction and fixation failure of the femoral inter-trochanteric fracture and femoral neck fracture.Methods Between Aug 1998 and Mar 2009,21 patients who underwent reduction and fixation failure of the femoral inter-trochanteric fracture（12 cases） and femoral neck fracture（11 cases） in our hospital were included in this study.11 were males and 10 were females,with age ranging from 37 to 87 years,66.3 years in average.The internal fixation types included：five cases of DHS,two cases of DCS,one case of PFN,two cases of Gamma nail,one case of Hansson nail,one case combining the proximal femur comminuted fracture using internal fixation with interlocking nails,and nine cases of cannuiated screws.The reasons of failure were as follows：avascular necrosis of the femoral head in seven cases,fracture nonunion in seven cases,fracture nonunion with avascular necrosis of the femoral head in two cases,and fracture displacement or nonunion because of nail loosening or cutting in five cases.19 of 21 patients had shortened limbs because of fixation failure.Types of prosthesis：six of uncemented prothesis,four of cementedprothesis,11 of mixed type.The curative effects were evaluated by postoperation function improvement,restoration of extremity length,and incidence of complications.The relationships of age,the interval of two operations,limb legnth discrepancy,and clinical effects were also analyzed.Results No patients died in hospital,and four patients died because of systemic diseases in follow-up.Harris Hip Scores improved from 27.53±2.96 to 80.76±4.25 after THA in latest follow-up.Limb length discrepancy was 2.67±1.06 cm preoperative,and was reduced to 0.85±0.88 cm after operation.The younger the patients were,the longer the interval of reoperation was;the more severe the discrepancy before THA was,the more difficult the restoration of extremity length was.Complications were as follows：one case of postoperative traumatic mental disorders recovered after tremtment;one case of postoperative dislocation who had manual reduction under anesthetization and fixation with abduction braces for six weeks;one case of proximal femur cleavage fracture without treatment;one case of loosening who died of cerebrovascular accident two years after THA.Conclusions THA is an effective remedial method for internal fixation failure in the hip fracture and should be performed as soon as possible.It is necessary to make comprehensive evaluation and consideration according to individual pathological changes in different cases.
出处
《中华关节外科杂志（电子版）》
CAS
2012年第2期44-47,共4页
Chinese Journal of Joint Surgery(Electronic Edition)
关键词
骨折
内固定器
治疗失败
髋
关节成形术
评价研究
Fractures
bone
Internal fixators
Treatment failure
Hip
Arthroplasty
Evaluation studies
作者简介
通信作者：马若凡 E—mail：mamofan_syx@yahoo．com.cn
