严重髋臼骨折选择性早期全髋置换临床观察

Selective acute total hip arthroplasty for severe acetabular fracture

目的对于严重的髋臼骨折,进行切开复位内固定术很难取得满意的疗效,探讨施行一期的全髋置换术。并对疗效进行了评价。方法1997～2003年间,对17例髋臼骨折移位的患者施行了一期全髋置换术。并对其随访平均2.1年(1～6年)。由损伤到关节置换手术时平均8d(5～21d)。平均年龄53岁(26～69岁)。进行紧急全髋置换的指征包括关节内粉碎性骨折,关节面软骨全厚磨损丧失,股骨头嵌插,髋臼压缩下陷波及超过40%关节面以及负重区。结果最后一次随访是根据Harris评分,平均为82分(69～100分);15例疗效为优良;1例发生异位骨化,直至结束随访时没有松动;1例发生髋臼杯严重中央移位。结论对严重类型的髋臼骨折病人,常规切开复位内固定术难以取得良好疗效,施行紧急全髋置换术是有效的。但手术最好由经验丰富的骨科医生施行。

Objective: To investigate effect of the selective emergent total hip replacement for severe fracture of acetabulum. Method: Total hip replacement were carried on 17 cases of severe fracture of acetabulum during 1997～2003.All cases were followed up for averaged 2.1 years.The period from fracture to operation were 8 days (5d～2ld).The average age of the patients were 53 year old(26～69).The operative indication:splintered fracture inside the joint, the damage of all the cartilage on the articular surface,compact of the femoral head,the sag which was refered to more than 40% of the articular surface of the acetabular bone.Result: The last follow up was gained 82(69～100) points according to the Harris score. The effects of the 15 cases were good.The heterotopic ossification was taken place in 1 case.Until the last follow up there was not a case of lossening of artificial joint.There was one case occuring central acetabular cup displaced.Conclusion: For the patients with severe fracture of acetabulum, it is effective to carry on total hip replacement.