人工关节置换术治疗内固定失败的髋部骨折的疗效分析

Treatment of Failed Internal Fixation of Hip Fracture with Total Hip Arthroplasty

目的分析髋部骨折内固定术治疗失败后采取人工髋关节置换术治疗的疗效。方法回顾分析我科自2012年6月至2016年6月采用人工髋关节置换术治疗的30例髋部骨折内固定失败的患者。其中,股骨颈骨折内固定失败的患者21例,股骨转子间骨折内固定失败的患者6例,髋臼骨折内固定失败的患者3例。30例患者均采用全髋关节置换术和生物型髋臼杯固定。28例采用生物型股骨柄固定,2例患者因骨质疏松严重而行骨水泥型股骨柄固定。结果所有患者均手术顺利,无术中并发症发生,手术时间(85±22)min。术后随访10~24个月,平均15.7个月。所有患者伤口愈合良好,至末次随访时未发现假体下沉、松动、脱位等现象。Harris评分由术前的52~78分(平均68.5分)提高到末次随访的85~96分(平均92.6分)。依据Harris评分(满分100分,90分以上为优良,80~89分为较好,70~79分为尚可,小于70分为差)进行疗效评价,优良28例,较好2例,优良率86.7%。结论髋部骨折内固定术失败后行人24例,良工髋关节置换术治疗,手术安全,疗效可靠,患者的关节功能障碍和疼痛得到明显改善。可最大程度恢复关节功能,减轻疼痛,减少关节失用带来的各种并发症,有利于提高患者的生活质量。

Objective To evaluate the clinic effects of THA in failed internal fixation of hip fracture.Methods 30 patients treated from June 2012 to June 2016 were retrospectively analyzed to evaluate the curative effects of total hip arthroplasty.There were 21 patients with failed internal fixation of femoral neck fracture,6 with failed fixation of intertrochanteric fracture,3 with failed fixation of acetabular fracture.Results All of the 30 patients underwent a successful operation and no complication occurred.The mean operation time was（85±22）mins.The patientswere followed up for15.7 months（10~24 months）.The average Harris Hip Score was improved from 68.5（range：52~78）preoperative to92.6（range：85~96）postoperative.The good and excellent rate was 86.7%.There were no prosthesis loosening,sinking and dislocation at final follow-up.Conclusion Total hip arthroplasty is a effective,safetreatment option for failed internal fixation of hip fracture.It can recover the hip joint function and alleviate the hip pain.At the same time,it can lessen those complications resulted from the joint dysfunction and improvethe lifequalitiesof patients.