髋臼骨折后全髋关节置换效果分析

Retrospective analysis of results of total hip replacement after acetabular fracture

目的 总结分析髋臼骨折后全髋关节置换的特点及效果,为治疗提供依据.方法 选取全髋关节置换方法治疗的髋臼骨折58例患者的临床资料进行回顾性分析.结果 58例（59髋）中,行切开复位内固定（open reduction and intemal fixation,ORIF）治疗46例（79%）,非ORIF固定7例（12%）,非手术治疗5例（9%）;关节置换术前术中检查确定存在感染者共13例,均为ORIF病例,占28%,均行清创骨水泥占位器置入,二期翻修.其余病例行一期关节置换.平均随访45个月（20～58个月）,Harris评分由平均术前的48.2分提高到87.3分,并发症6例,髋关节脱位3例（5.2%）,经手法复位石膏固定治愈;深部感染2例（3.4%）,经二期翻修治愈.结论 关节置换可获得良好效果,但应注意排除术前存在感染,并注意预防术后并发症.

Objective To analyze the characteristic features of total hip replacement after acetabular fracture and provide ex- perience in treatment of these patients. Methods The acetabular fracture patients who were treated by total hip replacement in this hospital since September 2008 to October 2010 were recruited and the results of treatment were reviewed. Results Totally 58 cases （59 hip） , male 39 cases （40 hip） , 19 female cases （19 hip）. ORIF 46 cases, non-ORIF 7 cases, conservative treatment 5 cases. 13 cases （28%） had infection before total hip replacement and were treated by eradication, spacer implant and second stage revision. Other patients received replacment directly. Average follow-up time was 45 months （20-58 months）. Harris score was 48.2 before total hip replacement and increased to 87.3 till the final follow-up. 6 cases had complications. 3 cases had dislocation and were treated by closed reduction, plaster fixation and all were cured. 2 eases had deep infection and were sueeessfully treated by two stage revision. Conclusions Acetabular fracture is treated by open reduction and internal fixation in acute stage. In later stage, patients with non-u- nion, malformation union, osteoarthritis, and infeetion need total hip replacement. Total hip replacement can achieve good results. But the infection should be eliminated before total hip replacement and postoperative complication should be prevented.