全髋关节置换术治疗股骨颈骨折内固定术后股骨头缺血性坏死疗效分析

Total hip arthroplasty for avascular necrosis of femoral head after operation of femoral neck fractures

目的探讨全髋关节置换术(THA)治疗股骨颈骨折内固定术后股骨头缺血性坏死的疗效。方法回顾性分析自2011-03—2016-02采用THA治疗的40例股骨颈骨折内固定术后股骨头缺血性坏死。比较术前及末次随访时的疼痛VAS评分、髋关节功能Harris评分。结果本组切口均一期愈合,未发生感染、坐骨神经损伤、下肢深静脉血栓等并发症。40例均获得随访,随访时间12~68(31.7±9.5)个月。末次随访时X线片显示髋关节假体稳固,位置满意,无松动。末次随访时疼痛VAS评分、髋关节功能Harris评分均较术前明显改善,差异有统计学意义(P<0.05)。末次随访时髋关节功能:优28例,良11例,可1例,优良率97.5%。结论股骨颈骨折内固定术后骨折可良好愈合,但继发股骨头缺血性坏死的发生率依然较高。股骨颈骨折内固定术后股骨头缺血性坏死行THA治疗效果满意,是未来主要研究方向。

Objective To analyze the treatment effect of total hip arthroplasty （THA） for avascular necrosis of femoral head after operation of femoral neck fractures. Methods Forty patients with avascular necrosis of femoral head afier operation of femoral neck fracture were retrospectively analyzed, who had undergone THA treatment from March 20ll to February 2016. The Harris scoring system and visual analogue scale （VAS） before operation and at last follow-up were compared. Results The incision was healed primarily in all patients, without wound infection, sciatic nerve injury, deep vein thrombosis and other complications. All 40 cases were followed up for 12-68 （31.7±9.5） months. The X-ray showed that all the hip prosthesis was stable at the last follow-up. The positions were satisfactory and no loosening was found. At the last follow-up, the Harris score and VAS score were better than those before operation, the differences were statistically significant （P 〈0.05）. The Harris score of last follow-up, 28 cases were excellent, l l good, 1 acceptable, the excellent and good rate was 97.5%, Conclusion Fractures of femoral neck can be healed well after internal fixation, but the incidence of avascular necrosis of femoral head is still high. Femoral head avascular necrosis after internal fixation for femoral neck fractures can be treated with THA satisfactorily, which is the main research direction in the future.