摘要
目的:探讨Pinnacle ES限制性内衬全髋关节置换治疗下肢神经肌肉病变股骨颈骨折的早中期临床疗效。方法:回顾性分析2020年1月至2023年1月使用Pinnacle ES限制性内衬对下肢神经肌肉病变股骨颈骨折行初次全髋关节置换术并有完整随访资料的16例患者,男7例,女9例;年龄61~75(68.42±3.58)岁;左侧10例,右侧6例;股骨颈骨折GardenⅢ型11例,Ⅳ型5例;患肢合并小儿麻痹后遗症2例,帕金森病2例,脑梗后遗症12例;所有病例采用后外侧入路,通过影像学资料评价假体位置。采用Harris和Merle D'Aubigne髋关节评分进行髋关节功能评估,记录随访期间是否出现假体脱位、松动、感染等情况。结果:1例在术后2年死于晚期肿瘤,其余15例获得随访,时间24~64(34.8±5.5)个月。手术时间50~90(75.56±8.15)min,出血量150~200(170.32±12.56)ml。所有患者术后切口Ⅰ期愈合。术中2例出现股骨矩劈裂,予钛缆捆扎治疗,所有病例无神经血管损伤。Harris髋关节评分由术前的(18.95±2.25)分提高到末次随访时的(88.02±2.42)分;Merle D'Aubigne评分由术前的(3.05±0.06)分提高到末次随访时的(16.65±0.93)分。术后随访X线片显示假体位置良好,随访期间无脱位、假体松动、假体周围骨折及深部感染等并发症发生。结论:Pinnacle ES限制性内衬全髋关节置换治疗下肢神经肌肉病变股骨颈骨折,可有效改善髋关节功能,降低术后假体脱位率,具有良好的初始稳定性,早中期临床疗效满意。
Objective To investigate the short-to-medium-term clinical efficacy of total hip arthroplasty(THA)with Pinnacle ES constrained liner in the treatment of femoral neck fractures(FNF)associated with lower limb neuromuscular disorders.Methods A retrospective analysis was conducted on 16 patients who underwent primary THA using Pinnacle ES constrained liner for FNF with lower limb neuromuscular disorders and had complete follow-up data,treated between January 2020 and January 2023.There were 7 males and 9 females,with a mean age of(68.42±3.58)years old ranging from 61 to 75 years old.Among them,10 cases had left-sided fractures and 6 had right-sided fractures;based on the Garden classification,11 cases were typeⅢand 5 cases were typeⅣ.The affected limbs were complicated with sequelae of poliomyelitis(2 cases),Parkinson's disease(2 cases),and sequelae of cerebral infarction(12 cases).All operations were performed via a posterolateral approach.Prosthesis position was evaluated using imaging data.Hip function was assessed by the Harris hip score(HHS)and Merle D'Aubigne hip score.During the follow-up period,the occurrence of complications such as prosthetic dislocation,loosening,and infection was recorded.Results One patient died of advanced tumor 2 years after surgery,and the remaining 15 patients were followed up for 24 to 64 months with a mean of(34.8±5.5)months.The operation time ranged from 50 to 90 minutes with a mean of(75.56±8.15)minutes,and the blood loss ranged from 150 to 200 ml with a mean of(170.32±12.56)ml.All patients achieved primary wound healing after surgery.Intraoperatively,femoral calcar splitting occurred in 2 cases,which were treated with titanium cable binding;no neurovascular injuries were observed in any case.The mean HHS increased from(18.95±2.25)preoperatively to(88.02±2.42)at the last follow-up,and the mean Merle D'Aubigne Score increased from(3.05±0.06)preoperatively to(16.65±0.93)at the last follow-up.Postoperative follow-up X-rays showed good prosthetic position,and no complications such as dislocation,prosthetic loosening,periprosthetic fracture,or deep infection occurred during the follow-up period.Conclusion Total hip arthroplasty with Pinnacle ES constrained liner is effective in the treatment of femoral neck fractures associated with lower limb neuromuscular disorders.It can significantly improve hip function,reduce the postoperative prosthetic dislocation rate,provide good initial stability,and achieve satisfactory short-to-medium-term clinical efficacy.
作者
汪灿锋
王小青
韩雷
胡云根
王拓
WANG Can-feng;WANG Xiao-qing;HAN Lei;HU Yun-gen;WANG Tuo(Jiangnan Hospital Affiliated to Zhejiang Chinese Medical University,Hangzhou Xiaoshan Hospital of Traditional Chinese Medicine,Zhejiang 311201,Hangzhou,China)
出处
《中国骨伤》
2025年第11期1151-1155,共5页
China Journal of Orthopaedics and Traumatology
关键词
股骨颈骨折
下肢神经肌肉病变
限制性内衬
关节成形术
置换
髋
Femoral neck fracture
Neuromuscular diseases of the lower extremity
Constrained liners
Arthroplasty,replacement,hip
