摘要
目的探讨股骨头缺血性坏死伴转子部骨折行一次性人工全髋关节置换术的手术方法并总结其疗效。方法1997年7月-2005年9月,对18例股骨头缺血性坏死伴外伤性股骨转子部骨折患者行一次性人工全髋关节置换术。男13例,女5例;年龄32～60岁。原发性股骨头缺血性坏死11例,强直性脊柱炎2例,类风湿性关节炎2例,先天性双髋臼发育不良2例,股骨颈骨折行空心钉内固定术后1例。病程4～23年,平均8年。患者均为跌伤入院。左侧11例,右侧7例。X线片检查示均为股骨头缺血性坏死合并转子部骨折。骨折类型按Evan's分类,Ⅱ型4例,Ⅲ型6例,Ⅳ型5例,Ⅴ型3例。骨折侧股骨头缺血性坏死按照Ficat分类:Ⅲ型5例,Ⅳ型13例。受伤后2～12h入院。所有患者术前Harris评分平均35.2分。患者均采用全生物型人工关节。结果术后患者切口均Ⅰ期愈合。术后3d发生深静脉栓塞1例,对症治疗后痊愈。均无泌尿系统、肺部感染及褥疮发生。患者于术后6个月、1年及2年定期随访,术后4个月X线片检查示骨折端均愈合,假体形态及位置良好,无髋臼磨损及假体脱位。术后6个月患者均能生活自理。术后2年参照Harris人工全髋关节置换疗效标准评分平均94.7分,与术前Harris评分比较差异有统计学意义(P<0.05);优15例,良2例,中1例,优良率94.4%。结论人工全髋关节置换术治疗股骨头缺血性坏死伴股骨转子部骨折,是恢复髋关节功能的一种理想方法。
Objective To explore the way and therapeutic effect ot one stage total hip replacement （THR） m treating ischemic necrosis of femoral head combined with intertrochanteric fracture. Methods From July 1997 to September 2005, one stage THR was performed in 18 cases （11 left and 7 right） of ischemic necrosis of femoral head combined with fresh intertrochanteric fracture, including 13 males and 5 females, with an age range of 32-60 years. There were 11 primary cases, 2 cases of ankylosing spondylitis, 2 cases of rheumatic arthritis, 2 cases of congenital acetabular dysplasia and 1 case of femoral neck fracture fixed using cannulated cancellous screws postoperatively in all cases of ischemic necrosis of femoral head. They suffered from ischemic necrosis of femoral head for 8 years （4-23 years）. According to Evan＇s intertrochanteric fracture classification, there were 4 cases of type Ⅱ, 6 cases of type Ⅲ, 5 cases of type Ⅳ and 3 cases of type Ⅴ. According to the Ficat ischemic necrosis of femoral head classification, there were 5 cases of type Ⅲ, and 13 cases of type Ⅳ. The disease course was 2-12 hours. The average value of Harris evaluation was 35.2 preoperatively. The prosthesis of biology was used. Results All wounds healed by first intention. One case suffered deep venous thrombosis 3 days postoperatively and recovered completely after treatment. No infection of urinary system and lung as well as no bedsore occurred postoperatively. The X-ray films showed that the fracture ends healed and that prosthesis had good form attitude and position after 4 months of operation. All cases were followed up for 2 years. They could walk and take care of themselves after 6 months. The average value of Harris evaluation was 94.7 points postoperatively （P 〈 0.05）. The results were excellent in 15 cases, good in 2 cases, fair in 1 case according to Harris evaluation standard of THR; the excellent and good rate was 94.4%. Condusion One stage THR for treating ischemic necrosis of femoral head combined with intertrochanteric fracture can avoid secondary operation. It could resume the ideal function of the hip joint.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2008年第7期773-775,共3页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
股骨转子部骨折
股骨头缺血性坏死
全髋关节置换
Intertrochanteric fracture Ischemic necrosis of femoral head Total hip replacement
