【作者】 刘莹松；

【导师】 杨述华；

【作者基本信息】 华中科技大学 ， 外科学， 2010， 硕士

【摘要】 目的:分析全髋关节置换术和全髋关节表面置换术治疗髋臼骨折术后继发创伤性关节炎的临床疗效。探讨初次内固定术后并发症的预防,髋关节置换在此类患者中的应用以及术中相关问题。方法:自2004年8月至2009年8月,采用全髋关节置换术或全髋关节表面置换术治疗30例髋臼骨折术后继发创伤性关节炎患者。其中合并股骨头缺血性坏死者15例,异位骨化者19例。受伤到关节置换的时间47月(3～144月),关节置换年龄41.5±8.4岁(26～67岁)。术前骨折分型(按Letournel-Judet分型系统):简单类型骨折9例,复杂类型骨折21例。按美国矫形外科医师协会(AAOS)标准,16例患者存在髋臼骨缺损,其中Ⅰ型骨缺损4例,Ⅱ型骨缺损9例,Ⅲ型骨缺损3例。根据Harris髋关节评分系统及术后影像学资料对患者的手术疗效进行随访。结果:所有患者随访时间36.7月(6～66月)。按Harris评分由术前44.2±12.4分提高到术后最后一次随访时89.1±7.1分,比较差异有统计学意义(P<0.01),其中优20髋、良7髋,优良率达90%。23例全髋关节置换者中,随访时间41.5月(6～66月),Harris评分由术前45.5±13.6分提高到术后最后一次随访时88.5±7.8分,优良率为87%。7例全髋关节表面置换者中,随访时间20.9月(8～35月),Harris评分由术前39.7±6.0分提高到术后最后一次随访时平均90.9±4.3分,优良率为100%。全髋关节置换者中,2例非骨水泥型臼杯和1例骨水泥型臼杯出现非连续性X线透亮带,但无假体下沉或移位表现。全髋关节表面置换者中,假体均无明显X线透亮带及移位的表现。所有患者经关节置换后,无术后感染、关节脱位、严重的异位骨化及血管、神经损伤,至最后一次随访无翻修患者。结论:初次内固定手术,必须保证解剖复位,有效的固定,尽量避免创伤性关节炎的发生。尽管部分髋臼骨折术后继发创伤性关节炎的治疗难度增加,但通过细致的术前计划、充足的植骨修复、正确的选择假体类型、针对每一位患者个性化的治疗,能够取得良好的临床疗效。对于部分具备条件的患者,选择全髋关节表面置换治疗有一定优势。长期的临床疗效,需要进一步随访证实。更多还原

【Abstract】 Objective:To analysis the clinical results in total hip arthroplasty(THA) and total hip resurfacing arthroplasty(HRA) for posttraumatic arthritis secondary to open reduction and internal fixation(ORIF) of acetabular fractures and, in addition, discuss the prevention of postoperative complications in internal fixation of acetabular fractures and the issues related with operation in hip arthroplasty.Method:From August 2004 to August 2009, 23 total hip arthroplasties and 7 total hip resurfacing arthroplasties were performed in our department for posttraumatic arthritis secondary to acetabular fractures. The average period from fracture to arthroplasty was 47 months(3～144months). The average age at arthroplasty was 41.5±8.4 years(26～67years). According to Letournel-Judet system, these cases were classified as simple fracture patterns in 9, associated fracture patterns in 21. According to AAOS classification, acetabular bone stock deficiencies were found in 16 cases. Clinical results were evaluated by Harris hip score and radiographic results were analyzed by postoperative serial X-ray films.Result:All patients were followed up for an average period of 36.7 months(6～66 months). Harris Hip score increased from 44.2±12.4 to 89.1±7.1 points at the latest follow-up, and the excellent and good rate was 90%. There were significant statistical differences between preoperative and postoperative Harris score(P<0.01). 23 total hip arthroplasties were followed up for an average period of 41.5 months(6～66 months). Harris Hip score increased from 45.5±13.6 to 88.5±7.8 points at the latest follow-up, and the excellent and good rate was 87%. 7 total hip resurfacing arthroplasties were followed up for an average period of 20.9 months(8～35 months). Harris Hip score increased from 39.7±6.0 to 90.9±4.3 points at the latest follow-up, and the excellent and good rate was 100%. A partial radiolucent line was seen in two cementless acetabular cup and one cemented cup without signs of prosthesis subsidence or migration in total hip arthroplasty. The prosthesis was no radiolucent lines and signs of subsidence or migration in total hip resurfacing arthroplasty. The results revealed that there were no postoperative infections, hip dislocation, significant heterotopic ossification occurred, blood vessel or nerve injury in the follow-ups. Furthermore there was no patient with cup or stem revised.Conclusion:Open reduction and internal fixation of an acetabular fracture must ensure anatomic reduction and fixation, and try to avoid the occurrence of traumatic arthritis. Although in the most of posttraumatic arthritis secondary to open reduction and internal fixation of acetabular fractures increases the difficulty of operative treatment, it can achieve a fine clinical result with Total hip arthroplasty by careful surgical plans, sufficient bone grafts and correct choice different type prostheses. There are certain advantages for some patients who are fit for the conditions with total hip resurfacing arthroplasties. However, the long-term efficacy needs further follow-up.更多还原