带翼加强杯Ⅰ期治疗髋臼合并同侧股骨颈骨折

The Application of Endo-model Partial Pelvis Replacement in Acetabular Fracture with Ipsilateral Neck Fracture Treated by Total Hip Arthroplasty

目的：探讨带翼加强杯在Ⅰ期全髋关节置换治疗髋臼骨折合并同侧股骨颈骨折中的应用。方法对12例合并同侧股骨颈骨折的髋臼骨折行Ⅰ期全髋关节置换术（total hip arthroplasty，THA）。伤后5~18 d 接受 THA，12例均采用带翼加强杯合并自体植骨行髋臼侧固定，股骨侧均采用生物型固定。根据 Harris 评分和 X 线片对其临床效果进行评估。结果12例患者均得到随访，平均随访时间3年9个月（2年1个月~5年7个月）。2例出现异位骨化，无脱位，未见假体移位及透亮带，无再翻修病例。术后 Harris 评分平均90分，较术前平均改善51分。所有随访患者髋关节功能均有明显改善，随访期内未发现假体松动。结论应用带翼加强杯行Ⅰ期全髋关节置换术是治疗髋臼骨折合并同侧股骨颈骨折的有效方法，这种方法强调髋臼重建结构的稳定性，避免了切开复位内固定引起的股骨头坏死等严重髋关节并发症，能显著改善关节功能，避免多次手术，减少患者的精神和经济负担。

Objective To evaluate the application of endo_model partial pelvis replacement acetabular fracture with ipsi_lateral neck fracture treated by total hip arthroplasty. Methods One stage THA was done in 12 patients with acetabular frac_tures combined with ipsilateral femoral neck fractures 5 ~ 18 days after fractures. All 12 patients received auto graft with Endo_model partial pelvis replacement and biological femoral stem. Harris Hip Score System and radiography were used to evaluate the clinical efficiency. Results 12 patients were followed up for 2 years and 1 months to 5 years and 7 months（mean 3 years and 9 months）,which showed heterotopic ossification in one patient and no dislocation. No prothesis loosening,radiolucent lines were observed during the follow_up. None needed second revision. The mean Harris Hip Score was 90 points,51 points higher than preoperative. The hip joint function was reported to be improved obviously and no loosening of prosthesis after oper_ation in all the patients followed up. Conclusion An analysis was done on six patients with acetabular fracture with ipsilateral neck fracture treated by total hip arthroplasty by auto gaft with Endo_model partial pelvis replacement and emphasizing the sta_bility of rebuilded configuration of acetabulum. The good curative effect with acetabular fracture with ipsilateral neck fracture can be obtained by total hip arthroplasty which can avoid femoral head necrosis and other serious complications by open reduc_tion and internal fixation and improve function of hip joint significantly,avoid further operation lessen the burden of patients mentally and economically.