特殊类型髋臼骨折的一期全髋关节置换

背景：髋臼骨折最有效的治疗方法是采用切开复位内固定。然而某些特殊类型的髋臼骨折切开复位内固定治疗预后均不理想，容易发生创伤性关节炎和股骨头缺血性坏死等并发症。 目的：观察特殊类型髋臼骨折患者行切开复位内固定一期全髋关节置换的效果。 方法：髋臼骨折12例，车祸伤7例，压砸伤3例，坠落伤2例。骨折类型：后壁骨折2例，后柱伴后壁骨折2例，T型骨折1例，横行伴后壁骨折5例，臼顶粉碎性骨折2例。伴有股骨头中心性脱位1例，后脱位5例，股骨头骨折3例。患者受伤前患有髋关节骨性关节炎3例，股骨头缺血性坏死2例。采用髋臼骨折切开复位内固定一期全髋关节置换，其中生物型假体9例，骨水泥型假体3例。入院距置换时间3-15 d，平均6 d。置换后第1年每2个月随访患者1次，应用Harris评分评估髋关节功能恢复情况。 结果与结论：12例患者置换后无伤口及深部感染，无关节脱位，无下肢深静脉栓塞，无死亡病例。其中11例获得长期随访，时间6-82个月。复位的髋臼骨折在6-16个月愈合，无假体松动及下沉等。末次随访时根据Harris评分法评估髋关节功能恢复情况：优8例，良2例，可1例，优良率为91%。髋臼骨折切开复位内固定一期全髋关节置换可避免长期卧床，尽早下床活动及有效的肢体功能训练，减少并发症，进而重建一个无痛的、功能良好的髋关节。

One-stage total hip arthroplasty for the treatment of special acetabular fracture

BACKGROUND: The most effective method for the treatment of acetabular fracture is open reduction and internal fixation, however, this treatment for some special types of acetabular fracture cannot get satisfactory prognosis, and is prone to complications, such as traumatic coxarthrosis and avascular necrosis of femoral head. OBJECTIVE: To evaluate the curative effect of open reduction and internal fixation and total hip arthroplasty in the treatment of special acetabular fracture. METHODS: Twelve cases of acetabular fracture were included, including seven cases of traffic accident wound, three cases of crush injury, and two cases of falling injury. The type of bone fracture: two cases of posterior wall fracture, two cases of posterior column and posterior wall fracture, one case of T shaped fracture, five cases of transverse and posterior wall fracture, and two cases of acetabular roof sexual fracture. Complications: one case was femoral head centric dislocation, five cases were latter dislocation, and three cases were caput femoris fractures. Before injury, three cases had coxarthrosis, and two cases were avascular necrosis of femoral head. All the cases were treated with open reduction internal fixation and total hip arthroplasty, of which nine cases were treated with biological prosthesis, and three cases were treated with bone cement prosthesis. The time from hospitalization to surgery was 3-15 days, and average was 6 days. The patients were followed-up once every 2 months in 1 year after replacement, and the Harris score was used to evaluate the hip function recovery. RESULTS AND CONCLUSION:No surgical site and deep wound infection, joint dislocation, lower limb deep vein thrombosis, and death were found in these 12 cases. Among them, 11 cases were followed-up for a longtime; the follow-up was lasted for 6-82 months. The acetabular fracture was healed at 6-16 months after reduction without prosthesis loosening and sinking. The hip function was evaluated during final follow-up according to the Harris score: excellent in eight cases, good in two cases, poor in one case, and the excellent and good rate was 91%. Open reduction internal fixation and one-stage total hip arthroplasty can avoid long-term bed, get out of bed as soon as possible, and reduce complications, thus reconstruct the hip joint painlessly and good functionally.