陈旧性股骨颈骨折的全髋关节置换术

Retrospective analysis of the total hip arthroplasty following obsolete femoral neck fracture

目的探讨全髋关节置换术（total hiparthropl asty，THA）治疗陈旧性股骨颈骨折的假体选择与技术特点。方法2001年10月至2006年11月因陈旧性股骨颈骨折接受THA患者60例，男30例，女30例；年龄30-80岁，平均57．5岁。按骨折后经保守治疗（23例）或内固定治疗（37例）分组。比较两组股骨柄使用类型、髓腔张开指数、骨质疏松程度。分析术前、术后肢体长度差、股骨头加长长度及旋转中心位置。结果41例获得随访，平均随访时间为18．4个月（2～48个月）。（1）保守治疗与内固定治疗组骨水泥型柄使用率分别为61％、27％（P〈0．05）；术前患侧股骨髓腔张开指数分别为2．62±0．85、3．23±0．68（P〈0．05）；Barnett指数分别为0．40±0．15、0．48±0．08（P〈0．05）；股骨距平均长度为（0．9±0．6）cm；（2）53％的患者术前髋臼侧骨质疏松等级患侧大于健侧；术后Delee1、2、3区出现透光线的患者分别占33％、15％及17％（P〈0．05）；（3）术前、术后平均肢体长度差分别为（21．8±13．0）mm、（1．5±6．7）mm，股骨头平均加长（5．4±2．2）mm。结论经内固定治疗后的患者骨质及形态优于经保守治疗者，内固定组股骨柄易被置于内翻位。陈旧性股骨颈骨折多伴有骨质疏松，易发生过度磨锉，导致髋臼安置上移。骨折后瘢痕组织弹性差，易过度松解而不得不使用加长股骨头颈，因此术中应注意软组织松解的程序和范围。

Objective To investigate the prosthesis selection and techniques for total hip arthroplasty （THA） in patients suffered obsolete femoral neck fracture. Methods From October 2001 to November 2006, a total of 60 patients underwent THA due to obsolete femoral neck fracture were entered in the study, including 30 males and 30 females with an average age of 57.5 years. According to the initial treatment, the patients were divided into expectant treatment group and internal fixation group. Our research compared the type of femoral components, canal flare index and extent of osteoporosis, calculated the limb discrepancy, head length and the position of rotating center. Mean follow-up was 18.4 months. Results 1） 61% and 27% cemented components were utilized in preservation group and internal fixation group, respectively. Furthermore, the mean flare and Barnett indices were 2.62±0.85, 3.23±0.68 and 0.40±0.15, 0.48±0.08, respectively. 2） The osteoporosis grade, which the involved side outweighed the healthy appeared in 53% patients. There were 20, 9 and 10 cases characterized by radiolucencies in zone of Delee 1, 2 and 3, respectively. 3） The pre- and postoperative limb discrepancies were （21.8±13.0） mm and （1.5±6.7） ram, respectively. The mean head length was （5.4-±2.2） ram. Conclusion Compared to expectant treatment, patients received internal fixation will preserve better bone quality for THA. We should pay more attention to the following points： over reaming responsible for upper shifting of the acetabular component is more common in obsolete femoral neck fracture patients due to osteoporosis. Although the proximal femur moves upward for soft tissue contracture, excessive release will necessitate the lengthened femoral head.