髋部骨折内固定术后继发创伤性髋关节骨性融合的全髋关节置换

Total hip arthroplasty for post- traumatic bony fusion secondary to acetabular fracture fixation

[目的]探讨采用全髋关节置换术治疗髋关节创伤性骨性融合的临床疗效及异位骨化处理与防治对策。[方法]回顾性分析本院2010年8月∽2013年10月采用生物型全髋关节置换治疗髋部复杂性骨折切开复位内固定术后继发创伤性髋关节骨性融合8例患者的临床资料。8例均为男性;年龄（23∽49）岁,平均35.8岁。采用股骨颈楔形截骨解除髋关节骨性融合状态,在C型臂X线机透视下定位髋臼旋转中心,髋臼锉进行髋臼研磨后采用合适的髋臼前倾角置入髋臼假体。以髋关节Harris评分评价术前及术后末次随访时的髋关节功能。[结果]术后随访时间15∽48个月,平均28.5个月。术前髋关节Harris评分平均（22.7±3.7）分,术后末次随访时Harris评分平均（93.8±5.2）分,差异有统计学意义（t=31.32,P=0.00）。术中未发生骨折及神经、血管损伤等并发症。[结论]全髋关节置换术治疗髋臼骨折术后继发创伤性髋关节骨性融合可获满意近期疗效。采用股骨颈楔形截骨可安全、有效地解除髋关节骨性融合状态。选择适配的生物型人工髋关节假体并以合理的角度安装,最终获得一个稳定的、具有正常解剖位置的人工全髋关节。

[Objective]To evaluate the clinical effect of cementless total hip arthroplasty（ THA） in treatment of post- traumatic hip bony fusion secondary to acetabular fracture fixation. [Method]A retrospective analysis was made on the clinical data from 8 patients（8 hips） who underwent THA between August 2010 and October 2013. All cases were male,with average age of35. 8 years（23 - 49 years）. The hip bony fusion was relieved by wedge shape osteotomy at femoral neck level and the center of acetabular rotation was directed under C- arm fluoroscopy guidance. The acetabular cup was placed in 40° of vertical inclination and 15° of anteversion. The Harris evaluation system was performed to assess the hip function preoperatively and postoperatively. [Result]All the patients were followed up for a mean of 28. 5 months（ range from 15 to 48 months）. The mean Harris hip score increased from preoperative（22. 7 ± 3. 7） points to postoperative（93. 8 ± 5. 2） points. No vessels and nerve damage occurred in operation. [Conclusion]THA has satisfactory short- term effectiveness for post- traumatic hip bony fusion secondary to acetabular fracture fixation. The hip bony fusion can be safely relieved by wedge shape osteotomy in femoral neck. The satisfactory result of THA is based on good selection of cementless acetabular component and the right placement of the implants at the level of true acetabulum.