股骨颈骨折内固定失败后的全髋关节置换术和初次全髋关节置换术的对比研究

A comparative study of total hip arthroplasty after failure of internal fixation and primary total hip arthroplasty for femoral neck fracture

背景:股骨颈骨折内固定失败后多采用全髋关节置换术(THA)来修复,其难度要大于初次THA,且安全性和有效性尚无定论。目的:比较股骨颈骨折内固定失败后的THA和移位股骨颈骨折一期行THA的临床效果。方法:回顾性分析2005年6月至2017年1月收治的因股骨颈骨折内固定失败后接受THA的患者34例(观察组)和因移位股骨颈骨折接受一期THA的患者44例(对照组)。比较两组患者行THA的手术时间、切口长度、术中出血量、术后引流量、输血量、住院时间;术前和随访时进行髋关节功能Harris评分和KPS生活质量评分。结果:全部获得随访,随访时间为2.5~12年,平均(6.8±4.3)年。观察组与对照组在手术时间、切口长度、失血量和术后随访Harris评分上的差异有统计学意义(P<0.05);两组在住院天数、术后KPS评分以及输血量上的差异无统计学意义(P>0.05)。两组术后短期内均未发生假体周围感染、松动等并发症。结论:THA是股骨颈骨折内固定失败后的一种有效补救措施,但相比一期THA的手术创伤更大,预后关节功能也略差。

Background:Total hip arthroplasty(THA)is often used to treat the failure of internal fixation for femoral neck fractures.The difficulty of such revision surgery is greater than that of primary THA,and their safety and efficacy are still not certain.Objective:To compare the clinical effect of THA after the failure of internal fixation for femoral neck fracture and primary THA for displaced femoral neck fracture.Methods:Retrospective analysis was performed on 34 patients(study group)who received THA after failure of inernal fixation for femoral neck fracture and 44 patients(control group)who received first-stage THA for displaced femoral neck fracture from June 2005 to January 2017.The operation duration,incision length,intraoperative blood loss,postoperative drainage volume,blood transfusion volume,hospital stay and Harris hip score and KPS quality of life score performed preoperatively and postoperatively were compared between the two groups.Results:All patients were followed up for 2.5-12 years,with an average of(6.8±4.3)years.There were statistically significant differences in the operation duration,incision length,blood loss and Harris hip score of postoperative follow-up between the two groups(P<0.05).There were no significant differences in hospital stay,postoperative KPS score and blood transfusion volume between the two groups(P>0.05).No complications such as periprosthetic infection and loosening occurred in the two groups within a short period of time.Conclusions:THA is an effective remedial measure after the failure of internal fixation of femoral neck fracture.However,the surgical trauma of the second stage THA is greater,and the postoperative joint function is slightly poorer.