髋臼骨折的全髋关节置换术治疗

Total hip replacement for acetabular fractures

目的探讨全髋关节置换术(THA)治疗髋臼骨折的手术技术及近期疗效。方法1998年10月至2005年6月,本组采用THA治疗髋臼骨折合并创伤性髋关节骨关节炎患者27例28髋,其中13例初期采用切开复位内固定治疗,14例初期采用保守治疗。术前骨折分型(根据Letournel-Judet分型系统):后壁骨折(16例),横行骨折(1例),后柱+后壁骨折(3例),横行+后壁骨折(4例),T形骨折(1例),双柱骨折(3例)。根据Harris髋关节评分系统分别对术前和术后疼痛程度、髋关节功能及活动度进行综合评分。结果随访资料完备者23例患者(24髋),随访时间5～78个月,平均24.7个月。术前Harris髋关节评分21～76分,平均50.1分;术后评分56～100分,平均90.2分,较术前有显著性提高(P<0.001)。其中18例优秀,4例良好,1例一般,1例较差。术前髋关节疼痛评分10～40分,平均24.6分;术后评分30～44分,平均41.1分。各有1例骨水泥型和非骨水泥型臼杯周围出现非连续性透亮带但未伴假体下沉或移位表现。术后未出现关节脱位、深部感染、严重异位骨化、医源性坐骨神经损伤或原有神经症状加重、下肢深静脉栓塞或肺栓塞等并发症。至最后一次随访尚无翻修患者。结论针对髋臼骨折合并创伤性髋关节骨关节炎患者施行THA,可有效缓解疼痛,改善髋关节功能及活动度且并发症少见。

Objective To evaluate short-term clinical and radiographic results of total hip arthroplasties with cemented or cementless reconstruction technique for posttraumatic arthritis after acetabular fractures.Methods From October 1998 to June 2005, 28 total hip arthroplasties were performed in our department for 27 acetabular fracture patients. The average age at arthroplasty was 43.5 years. Clinical results were evaluated by Harris hip score and radiographic results were analyzed by postoperative serial X-ray films. We compared the differences of arthroplasties in 13 patients who had had prior open reduction and internal fixation of their acetabular fractures with those in 14 patients who had had prior closed treatments. According to Letournel-Judet system, these cases were classified as Posterior wall fracture in 16, Transverse fracture in 1, Posterior wall-posterior column fracture in 3, Transverse-posterior wall fracture in 4, T-type fracture in 1 and Both column fracture in 3.Results The average duration of follow-up was 24.7 months （range, 5 to 78 months）. 4 patients （4 hips） lost follow-up. The average Harris Hip score increased from preoperative 50.1 （range, 21-76） to 90.2 points （range, 56-100） at the latest follow-up. A partial radiolucency was seen in one cemented acetabular cup and one cementless cup respectively without signs of cup subsidence or migration. There was none of the complications such as hip dislocation, deep infections, severe heterotopic bone formation, iatrogenic nerve injury or deteriorated pre-existent nerve symptoms, deep venous thrombosis or pulmonary emboli. No patient had cup or stem revised.Conclusions Total hip arthroplasty is a viable treatment for acetabular fractures combined with posttraumatic hip arthritis. It can effectively relieve pain and restore hip function with low rate of complications.