Ⅰ期全髋置换治疗严重髋关节骨性关节炎伴股骨近端骨折

Phase Ⅰ total hip replacement for severe hip osteoarthritis with proximal femoral fractures

目的:探讨Ⅰ期全髋置换治疗严重髋关节骨性关节炎伴股骨近端骨折的疗效及预后。方法:2014年7月至2017年10月,采用Ⅰ期全髋置换治疗8例严重的终末期髋关节疾病伴股骨近端骨折患者,男6例,女2例;年龄59~72岁,平均65岁;右侧股骨头坏死伴右侧股骨近端骨折4例,左侧股骨头坏死伴左侧股骨近端骨折3例,左侧髋臼发育不良伴左侧股骨近端骨折1例。患者受伤至手术时间平均7 d。8例患者均采用生物型加长柄人工髋关节假体。结果:8例Ⅰ期全髋置换患者术后均获得随访,随访时间12~48个月,平均31个月。随访期间假体无松动、下沉,Harris评分从术前平均33分(22~42分)提高到末次随访时平均87分(82~90分),其中优3例,良5例。术后3个月弃拐行走,术后3~6个月X线片显示骨折愈合良好,患者髋关节疼痛和功能明显改善,生活质量得到极大提高。结论:严重的髋关节骨性关节炎伴股骨近端骨折患者采取Ⅰ期全髋关节置换具有缩短治疗时间、减轻患者痛苦、减少住院费用、预后效果好等优点。

Objective:To investigate the effect and prognosis of stage I total hip replacement in the treatment of severe hip osteoarthritis with proximal femoral fracture.Methods:From July 2014 to October 2017,8 patients with severe end-stage hip disease and proximal femoral fracture were treated with stage I total hip replacement including 6 males and 2 females,aged 59 to 72 years old with an average age of 65 years old,involving 4 femoral head necrosis with proximal femoral fracture in the right side,3 femoral head necrosis with proximal femoral fracture in the left side,and 1 left acetabular dysplasia with proximal femoral fracture in the left side.The average time from injury to operation was 7 days.Eight patients were treated with biologically elongated hip prosthesis.Results:Eight patients with stage I total hip arthroplasty were followed up for 12 to 48 months with an average of 31 months.During the follow-up period,there was no loosening or subsidence of the prosthesis.Harris score increased from 33 points(22 to 42 points)preoperatively to 87 points(82 to 90 points)at the last follow-up.Among them,3 cases were excellent and 5 cases were good.Abandoned abduction and walked 3 months after operation.X-ray films during 3-6 months after operation showed that fracture healing was good,hip pain and function were improved significantly,and the quality of life was greatly improved.Conclusion:Phase I total hip arthroplasty for severe hip osteoarthritis patients with proximal femoral fracture has the advantages of shortening the treatment time,alleviating patients’pain,reducing hospitalization costs and good prognosis.