全髋关节置换术治疗髋臼骨折继发创伤性髋关节炎和股骨头坏死中远期疗效观察

Middle and long term results of total hip arthroplasties for secondary post traumatic arthritis and femoral head necrosis after acetabular fractures

目的 ：评价全髋关节置换术治疗髋臼骨折后继发创伤性髋关节炎或股骨头坏死的中远期疗效。方法 ：2000年1月至2005年12月,对33例髋臼骨折继发创伤性髋关节炎和（或）股骨头坏死患者实施全髋关节置换术。其中男21例,女12例;年龄27~69岁,平均52岁。23例骨折曾行切开复位内固定术,前侧入路5例,后侧入路12例,混合入路6例;10例行保守治疗。髋关节置换术均采用后外侧入路,术前髋臼骨折均已愈合,术中完全去除内固定5例,去除部分内固定3例,植骨20例。6例术中使用骨水泥假体,27例使用生物型假体。观察术中情况和术后并发症,比较术前Harris髋关节评分和术后10年评分,以假体松动、骨溶解或翻修为终点的生存分析显示假体10年生存率。结果：所有患者获随访,术后10年死亡1例,随访时间平均12年（10~15年）,术后10年时Harris髋关节评分较术前升高。1例假体早期无菌性松动行翻修术,2例骨溶解形成合并假体无菌性松动并行翻修术治疗,单纯骨溶解无假体松动1例,术后深静脉血栓4例,假体脱位2例,切口感染和假体周围感染各1例。假体10年生存率为84.8%（28/133）。结论：全髋关节置换术治疗髋臼骨折后继发创伤性髋关节炎或股骨头坏死能明显改善患者的髋关节的功能,并有较高的假体生存率,具有良好的中远期疗效,是一种有效的治疗手段。

Objective：To evaluate middle and long term results of total hip arthroplasties（THA） for the treatment of secondary hip traumatic osteoarthritis and femoral head necrosis after acetabular fractures. Methods：From January 2000 to December 2005,33 patients with secondary hip traumatic osteoarthritis and（or） femoral head necrosis after acetabular fractures were treated with THA. There were 21 males and 12 females,ranging in age from 27 to 69 years old,with an average of 52 years old. Twenty three patients were performed with open reduction and internal fixation ：5 patients were treated with anterior approach;12 patients,posterior approach;6 patients,combined approaches;other 10 patients,conservative treatment in the early stage. All THA were performed with posterior lateral approach. Bone union was achieved in the all acetabular fractures. Removal of all implants was necessary in 5 patients,and partial removal in 3 patients. Cemented cup was implanted in 6 patients and uncommented cup in 27 patients. Intraoperative and postoperative complications were observed,and Harris hip scores before surgery and 10 years after operation were compared. The prosthetic loosening,osteolysis or revision were used to evaluate10 years survival rate of prosthesis. Results：All the patients were followed up,and the duration ranged from 10 to 15 years,with a mean of 12 years. One patient died at the 10 th year after operation. The Harris score at the 10 th year was higher than the preoperative one. One and two patients were performed with revision total hip arthroplasty caused by aseptic loosening alone and aseptic loosening combined with osteolysis respectively. Osteolysis occurred in 1 patient;deep venous thrombosis in 4 patients;dislocation of prosthesis in 2 patients. One patient had infection of incision and one patient had infection around the prosthesis. Ten years survival rate of implant was 84.8%（28 / 133）. Conclusion：THA is an effective method to treat secondary hip traumatic osteoarthritis and（or） femoral head necrosis after acetabular fractures in improving hip joint functions with high implant survival rate and good middle and long term results.