股骨颈骨折内固定失败后行全髋关节置换的早期疗效分析

Early outcome of total hip arthroplasty for failed internal fixation of femoral neck fractures

目的观察股骨颈骨折内固定失败后行全髋关节置换术（totalhiparthroplasty，THA）治疗的早期疗效，探讨其手术技术及假体选择要点。方法回顾性分析2007年1月-2012年12月采用THA治疗股骨颈骨折内固定失败后患者36例，其中男21例，女15例；年龄46～72岁，平均58．6岁。内固定失败表现：股骨头坏死13例，骨折不愈合8例，骨折不愈合合并股骨头坏死15例。36例患者均采用生物型固定假体，其中25例患者选择近端固定的假体柄，11例患者选择远端固定的假体柄。采用Harris评分比较患者术前及随访时的患髋功能。结果所有患者均获得26～52个月随访，平均32．5个月。髋关节功能Harris评分由术前平均26．3分提高到术后83．6分，其中优12例，良22例，可2例，优良率94％。结论对于股骨颈骨折内固定失败的患者，行挽救性THA能有效改善髋关节功能，提高患者的生活质量。

Objective To detect the initial results of total hip arthroplasty （THA） after failure of internal fixation of femoral neck fractures and investigate the key points in surgical procedures and prosthesis selection. Methods A retrospective analysis was performed on 36 cases who had THA for femoral neck fractures due to the initially failed internal fixation between January 2007 and December 2012. There were 21 males and 15 females, with age ranging from 46 to 72 years （mean, 58.6 years）. After internal fixation, 13 cases were complicated by femoral head necrosis, eight fracture nonunion, and 15 fracture nonunion combined with femoral head necrosis. All the 36 cases had eementless THA, including proximally fixed stem in 25 cases and distally fixed stem in 11 cases. Harris hip score was assessed before operation and at follow-up. Results All the cases received a follow-up of 26-52 months （ mean, 32.5 months）. Mean Harris hip score improved from 26.3 to 83.6, including excellent results in 12 cases, good in 22, and fair in two, with excellence-good rate of 94%. Conclusion With respect to the failed internal fixation of femoral neck fractures, THA is an effective remedial method to improve hip function and quality of life of the patients.