人工全髋关节置换术治疗股骨颈骨折内固定术后股骨头缺血性坏死被引量：45

Total hip repalcement for osteonecrosis of the femaoral head after failed internal fixation of femaoral neck fracture

在线阅读下载PDF

导出

摘要目的探讨人工全髋关节置换术治疗股骨颈骨折内固定术后股骨头缺血性坏死的疗效。方法对泸州医学院附属医院骨与关节外科32例股骨颈骨折内固定术后股骨头缺血性坏死患者行人工全髋关节置换术。患者男18例,女14例,年龄35~62岁,平均50.6岁,左侧19例,右侧13例。手术后8~26个月确诊为股骨头缺血性坏死,平均17.1个月。人工髋关节置换时间距初次手术时间为15~48个月,平均27.2个月。股骨头缺血性坏死的X线Ficat分期：Ⅲ期8例,Ⅳ期24例。术前改良Harris评分（40.9±9.8）分。本组患者均采用生物型人工关节。结果术后切口均Ⅰ期愈合。全部患者随访6~48个月,平均28.3个月。末次随访Harris评分为（90.8±4.4）分,与术前比较差异有统计学意义（P〈0.05）。其中优25例,良5例,可2例,优良率93.8%。术中1例发生假体周围骨折（C型）,2例出现股骨近端劈裂骨折,相应处理后骨折均愈合。随访期间未见感染、脱位、假体松动等并发症发生。结论人工髋关节置换术是治疗股骨颈骨折内固定术后股骨头缺血性坏死的有效方法。 Objective To explore the therapeutic effect of total hip replacement（THR）in treating osteonecrosis of the femoral head（ONFH）after failed internal fixation of femoral neck fracture.Methods From January 2003 to June 2012,32cases（19left hips and 13 right hips）of ONFH after failed internal fixation of femoral neck fracture were treated with THR.There were 18 males and 14 females with an age range from 35 to 62years（mean,50.6years）.The ONFH was diagnosed at 8-26months（mean,17.1months）after internal fixation;the THR were conducted 15-48 months after first surgery（mean,27.2months）.According to Ficat classifi cation,there were 8cases at stageⅢ and 24 cases at stage IV.The Harris score was（40.9±9.8）.The prosthesis of biology was used.Results All wounds healed by first intention.All cases were followed up for 6-48months（mean,28.3months）.The Harris score was（90.8±4.4）at last follow-up,showing significant difference when compared with the preoperative value（P〈0.05）.The hip function were excellent in 25 hips,good in 5hips,fair in 2hip,and the excellent and good rate was 93.8%.There were 1cases of periprosthetic femoral fracture（type C）,2cases of proximal femoral splitting fractures fractures.After corresponding treatment,fracture was healed in all cases.There were no complications（infection,loosening dislocation or subsidence,etc）.Conclusion Total hip replacement is an effective method for the treatment of ONFH after failed internal fixation of femoral neck fracture.

作者谭美云郭杏张忠杰

机构地区泸州医学院附属医院骨与关节外科泸州医学院附属医院整形烧伤科

出处《重庆医学》 CAS 北大核心 2015年第5期633-635,共3页 Chongqing medicine

基金四川省教育厅科研项目(12ZB062)

关键词骨颈骨折股骨头坏死人工全髋关节置换内固定 femoral neck fracture femur head necrosis total hip arthroplasty internal fixation

分类号 R687.3 [医药卫生—骨科学]

作者简介谭美云（1974-），副主任医师，主要从事人工关节置换的基础与l临床研究。

引文网络
相关文献

参考文献11

1刘勇,孙磊.42例股骨颈骨折经皮空心螺钉内固定术临床观察[J].中国矫形外科杂志,2010,18(22):1930-1930. 被引量：2
2Seyfettinolu F,Ersan O’Kovalak E,et al. Fixation of fem-oral neck fractures with three screws: results and compli-cations[J]. Acta Orthop Traumatol Tur,2011,45(1):6-13.
3Haidukewych GJ. Salvage of failed treatment of femoralneck ?ractures[J]. Instr Course Lect,2009 ,58(1) :83-90.
4王广辉,许杰,郭坤营,董文武,马若凡.髋部骨折内固定失败后的全髋关节置换术疗效评估及影响因素分析[J].中华关节外科杂志（电子版）,2012,6(2):44-47. 被引量：29
5张秀丽,刘勇,任凯晶,刘军,朱本清,孙振辉.二期人工全髋关节置换治疗股骨颈骨折内固定术后股骨头缺血性坏死[J].中国修复重建外科杂志,2010,24(3):257-261. 被引量：6
6Byrd JW,Jones KS. Hip arthroscopy in the presence ofdysplasia[J]. Arthroscopy,2003,19(10) : 1055-1060.
7Archibeck MJ,Carothers JT,Tripuranent KR,et al. Totalhip arthroplasty after failed internal fixation of proximalfemoral fractures [J]. J Arthroplasty,2013,28 ( 1 ) : 168-171.
8Bhandari M, Devereaux PJ,Tornetta P 3rd, et al. Opera-tive management of displaced femoral neck fractures inelderly patients. An international survey[J]. J Bone JointSurg Am,2005,87(9) -2122-2123.
9Bhandari M,Devereaux PJ,Swiontkowski MF? et al. In-ternal fixation compared with arthroplasty for displacedfractures of the femoral neck. A meta-analysis[J]. J BoneJoint Surg Am,2003,85(9): 1673-1681.
10危杰,周力,王满宜,等.股骨颈骨折术后股骨头缺血性坏死的发生及转归[J].中华骨科杂志,2011,25 (5) :526-529.

二级参考文献27

1刘建国,陈洪瑜,姜涛,宋华伟,李贵斌,徐莘香.全髋关节置换与内固定治疗股骨颈骨折临床疗效分析[J].中国骨与关节损伤杂志,2005,20(10):652-654. 被引量：43
2刘粤,张长青,孟炜.闭合复位空心钉治疗中老年股骨颈骨折后股骨头坏死的多元相关研究[J].中华创伤骨科杂志,2006,8(7):617-621. 被引量：55
3Haidukewych GJ. Salvage of failed treatment of femoral neck fractures. Instr Course Lect, 2009, 58: 83-90.
4Angelini M, McKee MD, Waddell JP, et al. Salvage of failed hip fracture fixation. J Orthop Trauma, 2009, 23(6): 471-478.
5Byrd JW, Jones KS. Hip arthroscopy in the presence of dysplasia. Arthroscopy, 2003, 19(10): 1055-1060.
6Lowell JD. Results and complications of femoral neck fractures. Clin Orthop Relat Res, 1980, (152): 162-172.
7Bhandari M, Devereaux PJ, Swiontkowski MF, et al. Internal fixation compared with arthroplasty for displaced fractures of the femoral neck. A meta-analysis. J Bone Joint Surg (Am), 2003, 85(9): 1673-1681.
8Ravikumar KJ, Marsh G. Internal fixation versus hemiarthroplasty versus total hi p arthroplasty for displaced subcapital fractures of the femur-13 year results of a prospective randomized study. Injury, 2000, 31(10): 793-797.
9McKinley JC, Robinson CM. Treatment of displaced intracapsular hip fractures with total hip arthroplasty: comparison of primary arthroplasty with early salvage arthroplasty after failed internal fixation. J Bone Joint Surg (Am), 2002, 84 (11): 2010-2015.
10Koo KH, Ha YC, Jung WH, et al. Isolated fracture of the ceramic head after third-generation alumina-on-alumina total hip arthroplasty. J Bone Joint Surg (Am), 2008, 90(2): 329-336.