摘要
目的探讨人工全髋关节置换术治疗合并有晚期股骨头坏死的股骨转子间骨折的手术方法和临床效果。方法回顾性分析2010年6月至2015年10月期间收治的8例合并晚期股骨头坏死的股骨转子间骨折患者资料。男6例，女2例；年龄为45～67岁，平均53．5岁。股骨转子间骨折按Evans．Jensen分型：ⅠB型2例，ⅡA型5例，ⅡB型1例。8例均合并有晚期股骨头坏死：5例为缺血性坏死，按Ficm分期：Ⅲ期1例，Ⅳ期4例；3例为髋关节骨性关节炎合并股骨头坏死，按Tonnis分期均为Ⅲ期。采用人工全髋关节置换术治疗，取后外侧入路，在预定平面截断股骨颈后取出坏死股骨头，将股骨距下移复位，利用生物柄假体的顺行击入使股骨距实现压迫复位与固定。末次随访时应用髋关节Harris评分评定患髋功能。结果8例患者术后获平均25．5个月（12—45个月）随访。术后所有患者均实现股骨柄的生物性压配与初始稳定，术后3个月X线片示均获广泛性骨长入，达骨性固定。末次随访时8例患者的髋关节Harris评分平均为92．3分（89．98分），患者主观满意度良好。随访期间无一例患者发生感染、假体柄移位及断裂、骨溶解、脱位及关节不稳等并发症。结论对于合并有晚期股骨头坏死的股骨转子间骨折，全髋关节置换术同期解决了骨折固定与坏死股骨头置换的问题，能较快恢复患者髋关节功能。
Objective To explore the feasibility and therapeutic effects of total hip replacement （THR） for intertrochanteric fractures combined with late necrosis of the femoral head. Methods From June 2010 to October 2015, 8 patients underwent THR for intertrochanteric fractures combined with necrosis of the femoral head. They were 6 males and 2 females, with an average age of 53.5 years（from 45 to 67 years） . According to the Evans-Jensen classification, 2 fractures were type IB, 5 type HA and one type liB. All the 8 fractures were complicated with late femoral head necrosis, 5 cases of which were ischemic. According to the Ficat classification, the ischemic necrosis was type m in one and type 1V in 5 cases. In the other 3 cases, the necrosis secondary to the hip osteoarthrosis was type I]I according to the Tonnis classification. The necrotic femoral head was removed after osteotomy of the femoral neck via the posterolateral approach; after reduction of the femoral calcar, the intertrochanteric fracture was reduced and fixated in a press-fit manner through antegrade implantation of a biological stem prosthesis. Functional assessment of the affected hip was carried aut at the final follow-up using Harris scaring. Results The 8 patients were fallowed up for an average of 25.5 months （from 12 to 45 months）. After operation, biological press-fit and initial stability of the femoral stem were achieved in all the patients. The X-ray films showed bone ingrowth fixation in all the 8 hips at 3 months postoperatively. The Harris hip scores at the final follow-up averaged 92.3 （from 89 to 98）. The pa- tients showed fine subjective satisfaction. Follow-ups revealed no infection, prosthetic failure, osteolysis, dislocation or articular instability. Conclusion In treatment of intertrochanteric fractures combined with necrosis of the femoral head, THR can lead to fixation and reduction of the intertrochanteric fracture and re- placement of the necrotic femoral head at one stage, promoting functional recovery of the affec
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2017年第11期960-965,共6页
Chinese Journal of Orthopaedic Trauma
关键词
髋骨折
关节成形术
置换
髋
股骨头坏死
Hip fractures
Arthroplasty, replacement, hip
Femoral head necrosis
