金属对金属髋关节置换治疗髋臼骨折后创伤性关节炎

Metal on metal hip replacement for the traumatic arthritis developed from fracture of acetabulum

目的：探讨金属对金属髋关节置换治疗髋臼骨折后创伤性关节炎的临床疗效。方法：从2003年9月-2007年4月,共收治髋臼骨折行切开复位内固定术后发生创伤性关节炎11例,男9例,女2例年龄31-55岁,平均年龄43.2岁,体重指数20.3-29.2,平均24±2.3。车祸伤8例,高处坠落伤2例,重物砸伤1例,按letournel分类,后壁加后柱骨折3例,后壁骨折伴股骨头后脱位2例,横行伴后壁骨折2例,双柱骨折2例（其中1例伴股骨头中心性脱位）,横行骨折1例,后壁骨折1例。所有病例前次及本次手术前均行X线片、三维重建CT分别了解骨折及骨质缺损情况。本次手术术前和术后2年均行Harris评分评估髋关节功能情况。结果：术后手术切口均一期愈合,无脱位、神经或血管损伤发生。11例均获得随访,随访时间24-67个月,平均随访38.5±9.5个月。术后2年患髋Harris评分优2例,良8例,一般1例,优良率90.1%。结论：金属对金属髋关节置换治疗髋臼骨折后创伤性关节炎具有患髋功能保存好、并发症少、病患满意等优点,值得临床推广。

Objective：to explore the clinical curative effect of treatment for the traumatic arthritis developed from fracture of acetabulum with metal on metal hip replacement.Methods：a total of 11 cases（aged from 31～55,averaged 43.2 and the mean body mass index was 24±2.3,with a range between 20.3 and 29.2）of traumatic arthritis developed from open reduction and internal fixation for the fracture of acetabulum were admitted from September 2003～April 2007,among which 9 cases were male,2 female,and the aetiology of the acetabular fractures could be classified as follows：traffic accident trauma in 8 cases were,high falling injury in 2 cases,heavy pound in 1 case.According to the Letournel classification,there are 3 cases of posterior column accompanied with posterior wall fracture,2 cases of posterior wall accompanied with posterior dislocation,2 cases of transverse accompanied with posterior wall,2 cases of both column,one cases of posterior wall and one cases of transverse fracture.All the cases were examined before the former and this operation respectively by X-ray and 3D CT to evaluate the fracture configuration and the bone defect.The involved hip function was evaluated according to the Harris score pre-and 2 years postoperatively.Results：All the incisions healed by first intension,and no complications like dislocation, nerve and blood vessel injury were developed.All the 11 cases were followed up,time ranged from 24 to 67 months,and averaged 38.5± 9.5 months.According to the Harris score system,the involved hip function showed excellent result in 2 cases,satisfactory in 8 cases, poor in one case,and the excellent and the satisfactory cases accounted for 90.1%.Conclusion：Metal on metal hip replacement for the traumatic arthritis developed from fracture of acetabulum could preserve the hip function with less complications,which makes the patients satisfied and deserves clinical expansion.