应用人工髋关节置换术治疗髋部骨折内固定失败时假体的选择及术后疗效

Study on the effect of application of artificial hip arthroplasty in treatment of failure in internal fixation of hip and its postoperative effect

目的分析髋部骨折内固定失败后使用人工髋关节置换术治疗效果及假体的选择。方法选择100例髋部骨折内固定失败的患者,给予半髋关节置换术(半髋关节置换组)或全髋关节置管术(全髋关节置换组)治疗,对比两组患者手术相关指标,对比术前及术后6个月髋关节Harris分值、转子间骨折患者及股骨颈骨折患者肢体长度差和颈干角。术后6个月随访观察不良事件发生情况。结果半髋置换组术中出血量较全髋置换组少,手术时间较全髋置换组短(P<0.05);治疗后两组Harris分值均明显提高(P<0.05),但组间比较无显著差异(P>0.05);两组术后6个月转子间骨折患者肢体长度差和股骨颈骨折患者肢体长度差、颈干角均明显改善(P<0.05),但组间比较无显著差异(P>0.05)。随访无固定不良等情况。结论髋部骨折内固定失败后采用人工髋关节置换术能显著改善患者髋关节功能,应根据患者具体情况选择术式和假体。

Objective To analyze the effect of prosthetic hip arthroplasty and the choice of prosthesis after hip fracture. Methods A to- tal of 100 patients with hip fracture after failure in internal fixation were given with half hip replacement （ half hip replacement group） or total hip tube insertion （total hip replacement group ）, operation related indicators were compared between patients of these two groups, and the preopera- tive and 6 months postoperative Harris hip scores were compared, the body length and angle of neck stem in patients with rotor fracture and patients with femoral neck fracture were also compared between these 2 groups. The incidence rates of adverse events had been observed in 6 months follow - up period. Results The amount of intraoperative blood loss in half hip replacement group was less than that of total hip replacement group, and postoperative period was shorter than that of total hip replacement group （ P 〈 0.05 ）. Harris scores in patients of these two groups after treatment were significantly increased （ 19 〈 0.05 ）, but the difference was not significant between these 2 groups （ P 〉 0.05 ）. The difference in limb length and neck stem angle in patients of these 2 groups in 6 months after operation was significantly improved （ P 〈 0.05 ）, but the difference be- tween these 2 groups was not significant （ P 〉 0.05 ）. There was no bad fixation oceurred during the follow - up period. Conclusion Artificial hip arthroplasty can improve the hip function of patients after hip operation. The procedure and prosthesis should be selected according to the spe- cific situation of these patients.