全髋关节置换治疗创伤性股骨头坏死

Total hip arthroplasty for the treatment of traumatic avascular necrosis of the femoral head

目的：评价人工全髋关节置换术治疗创伤性股骨头坏死的疗效。方法对30例创伤性股骨头坏死患者行全髋关节置换术,术后摄片评估假体位置,比较术前和末次随访时Harris评分及VAS评分,采用欧洲生活质量评分体系（EQ-5D）评定患者的健康生活量。结果30例均获随访,时间8-86（32±4.3）个月。患者术后切口均一期愈合。未发生深静脉血栓、感染、脱位及坐骨神经损伤等手术并发症。末次随访X线片：5例骨水泥假体按Harris标准1例可能有松动（为髋臼骨折病例）,其余均无松动；25例生物型假体按Engh标准均为骨长入稳定,1例发生异位骨化（根据Brooker分级为Ⅰ级）。末次随访时Harris评分为82-99（92．00±4．26）分,VAS评分改善到0-4（0．98±1．21）分,EQ-5D评分为0．76-0．97（0．82±0．12）分,3项评分与术前比较差异均有统计学意义（P〈0．01）。结论全髋关节置换治疗创伤性股骨头坏死经过术前周密的安排、术中精细的操作可以取得满意的临床疗效。

Objective To analyze the outcome of total hip arthroplasty for traumatic avascular necrosis of femoral head （ ANFH） . Methods A retrospective study was made on 30 patients with ANFH who were treated with total hip ar-throplasty. The Harris hip score,VAS score and EQ-5D index score of pre-and post-operation were evaluated and the location of prosthesis by X-ray were assessed. Results All 30 cases were followed up for 8-86（32 ±4. 3） months. All incisions were healed primarily. There was no prosthesis infection, hip dislocation, and deep vein thrombosis or nerve injury in the follow-up. 1 possible loosing case was found in the 5 cemented ones and bone stability were ob-served in all cementless ones. 1 case was observed Brooker type Ⅰ heterotopic bone without treatment. The Harris hip score of the postoperatively follow-up were mean 92. 00 ± 4. 26（ranged,82-99）,the VAS score of the postopera-tively follow-up were mean 0. 98 ± 1. 21（ranged,0-4）,the EQ-5D index score of the postoperatively follow-up were mean 0. 82 ±0. 12（ranged,0. 76 -0. 97）. All scores were significantly higher than preoperative ones （P〈0. 01）. Conclusions Total hip arthroplasty for ANFH can achieve a fine clinical effect.