成人髋关节发育不良全髋关节置换术中股骨骨折的处理及预后

Treatment and prognosis of femoral fracture during total hip arthroplasty for patients with developmental dislocation of hip

目的通过临床病例探讨成人髋关节发育不良（DDH）全髋关节置换术（THA）中股骨骨折的处理及其预后。方法对2005年12月到2011年12月在DDH初次THA中发生股骨骨折的19例患者进行回顾性分析,根据骨折对股骨假体稳定性的影响将骨折分为稳定性骨折和不稳定性骨折,其中稳定性骨折8例,不稳定性骨折11例。对于稳定性骨折,采用保守治疗;不稳定性骨折采用切开复位钢丝环扎固定骨折。对患者术后骨折愈合情况和髋关节功能进行评价。结果 19例患者均获得随访,平均随访时间为15.6个月（12~25个月）,术后3~5月股骨骨折均愈合（平均14.5周）,对位和对线良好,无假体松动和下沉等术后并发症。髋关节Harris评分从术前平均57.4分增加到末次随访平均85.3分,较术前有显著性增加（P〈0.05）。结论成人DDH患者THA中发生股骨骨折给手术带来很大的挑战,延长了患者的康复时间,但是只要妥善处理仍然可以取得较好的术后效果,对假体的稳定性中期随访结果未造成影响。

Objective To investigate the treatment and prognosis of the femoral fracture during the total hip arthroplasty （ THA ） for the developmental dislocation of the hip （ DDH ） by clinical cases. Methods From December 2005 to December 2011, 19 DDH patients with the femoral fractures during the primary THA were retrospectively analysed. According to the stability of the femoral prosthesis after the femoral fractures, the patients were divided into the stable fracture group （eight cases ） and the unstable fracture group （11 cases ）. The stable fracture group adopted conservative treatment; and the unstable fracture group adopted steel wire-cerclage for fixation. The postoperative pain at the fracture site, fracture healing and the hip function were evaluated. Results 19 patients were followed up for a mean time of 15.6 months （6 -25 months） , and the fractures were healed after 8 -20 weeks （mean 13.8 weeks） ; no loosening, fracture or displacement of the prosthesis were observed. After the operation, one patient complained the pain in the involved limb, and one patient complained the ipsilateral knee stiffness. The Harris hip scores were 72 to 91 points, with an average of 85.34 points, and the excellent rate was 73%. The visual analogue scale scored 0 to 3 points for the pain at the fracture site while weight-bearing walk, with an average of 1.3 points. Conclusions The femoral fracture during the THA of DDH patients has brought great challenges, which prolongs the patient＇s recovery time, but better postoperative results still can be achieved by properly handling. The stability of the prosthesis in the mid-term follow-up may not be affected much.