髋臼骨折后全髋关节置换术的初步临床结果

Preliminary clinic results of total hip replacement after acetabular fractures

目的分析髋臼骨折术后全髋关节置换术的早期临床效果。方法2002年1月至2007年12月，共对18例髋臼骨折后创伤性髋关节关节炎的患者进行了全髋关节置换术，其中13例髋臼骨折做过切开复位内固定术，另5例行闭合复位骨牵引治疗；10例因为既往手术的疤痕粘连，关节置换时需行较广泛的软组织松解；9例在全髋关节置换术时仍有固定用的内植入物，5例术中需要取出内固定；12例术中用取下的股骨头行结构性或颗粒植骨；16例用非骨水泥髋臼，2例用金属加强环与骨水泥固定聚乙烯髋臼。术后随访行x线摄片评估，髋关节功能作Harris评分。结果随访时间6—70个月不等，平均38个月。3例术后发生髋关节周围BrookerⅡ度异位骨化，其中2例行异位骨化切除；1例术中股骨骨折，1例深部感染，1例髋臼松动并移位。最后随访时，12例（67％）患髋没有或仅偶有轻微疼痛，4例中度疼痛，2例疼痛需要助行工具；Harris评分由术前平均43．5分到术后平均84分。结论髋臼骨折后髋关节骨关节炎仍可通过全髋关节置换手术得到有效治疗，但其手术复杂程度与款臼骨折的处理有关，且并发症的发生率比一般的全髋关节置换手术高。

Objective To analyze the preliminary clinical outcome of total hip arthroplasty after acetabular fractures. Methods From January 2002 to December 2007, 18 patients with hip osteoarthritis after acetabular fractures underwent total hip arthroplasty. Among which, 13 had open reduction and internal fixation for the acetabular fractures while the other 5 only had bone traction. Extensive soft tissue release was done in 10 cases because of the scar adhesion resulting from the previous surgery. Existence of implants were found intraoperatively in 9 cases and had to remove them in 5 of the 9 cases. In 12 cases, the resected femoral heads were used to perform structural or cancellous bone graft during arthroplasty. Cementless acetabular cup was utilized in 16 cases while roof ring with cemented acetabular cup was used in 2 cases. The patients had radiological evaluation and Harris scoring in their follow-up. Results All patients were followed up with a mean of 38 （6 -70） months. Brook Ⅱ heterotropic ossification around the hip occurred in 3 cases and 2 of them underwent resection of the ossificant. The other complications included 1 case of intraoperative femoral shaft fracture, 1 case of deep infection and 1 case of acetabular component loosening and displacement. At the latest follow-up, 12 （67%） patients had no or occasional mild pain, moderate pain was existed in 4 patients and 2 patients needed walker in walking because of severe pain of the hip. The postoperative HHS was 8 4 points compared to 4 3 . 5 preoperatively. Conclusion Total hip arthroplasty could be an effective treatment of hip osteoarthritis following acetabular fractures, however the complicacy of the procedure depends on how the acetabular fractures had been treated, and the postoperative complication rate could be higher than that of the ordinary total hip arthmplasty.