人工关节置换治疗修复困难的股骨近端粉碎性骨折合并同侧髋臼骨折

Hip arthroplasty for the severe comminuted proximal femoral fracture with psilateral acetabulum fracture

目的：观察人工髋关节置换治疗修复困难的股骨近端严重粉碎性骨折合并同侧髋臼骨折的临床疗效。方法：对2007年6月至2013年9月收治的8例（8髋）股骨近端严重粉碎性骨折合并同侧髋臼骨折的患者采用人工髋关节置换,均为男性,年龄33-64岁,平均41.9岁。均采用生物型假体。采用Harris评分,从疼痛、功能及活动范围等方面进行随访,评价其疗效。结果：8例（8髋）患者术中无不良反应发生,术后卧床休息3个月,待髋臼骨折愈合后下床活动,无肺炎、褥疮等并发症发生。随访时间9-72个月,平均35.8个月。伤口均愈合,未发生假体下沉、松动现象。无脱位、感染发生。术后行走功能恢复正常（术后Harris评分平均87.5）。结论：人工关节置换治疗股骨近端粉碎性骨折合并同侧髋臼骨折患者,能最大程度恢复运动功能,减少创伤并发症,可作为内固定困难时的替代术式。远期疗效需进一步观察。

Objective：To investigate the results of hip arthroplasty for the treatment of severe comminuted proximal femoral fracture with ipsilateral acetabulum fracture. Methods：From June 2007 to September 2013,8 patients （8 hips） with severe comminuted proximal femoral fracture combined with ipsilateral acetabulum fracture were treated with hip arthroplasty. All patients were male and using biological prosthesis. Aged from 33 to 64 years old with an average of 41.9 years. According to Harris score in aspect of pain, function, range of motion to evaluate clinical effects. Results： There was no untoward reaction in 8 patients. And bed rest at 3 months after operation ,waiting for acetabulum fracture healed to out-of-bed activity. There was no complications such as pneumonia, bedsore and so on in the patients. Follow-up time was from 9 to 72 months with an average of 35.8 months, the wound healed, there was no the subsidence and loosening of prosthesis, no dislocation and infection. The mean of Harris score was 87.5 points after operation. Conclusion：The effect of the hip replacement in treating severe comminuted proximal femoral fracture with ipsilateral acetabulum fracture is confirmed. It can restore motor function and reduce traumatic complication, may serve as a substitute for internal fixation of difficult operation. The long term efficacy is necessary to further observe.