髋关节置换治疗伴有下肢短缩的陈旧性股骨颈骨折和股骨头坏死

目的:探讨髋关节置换术治疗伴有下肢短缩的陈旧性股骨颈骨折和股骨头坏死的疗效。方法:对23例伴有下肢短缩的陈旧性股骨颈骨折和股骨头坏死患者施行全髋关节置和双极人工股骨头置换,并进行随访。术前从临床和骨盆正位片X线测量了解下肢短缩程度,估计股骨颈截骨水平,术中软组织松解程度,调整骨水泥厚度和假体头颈长度等对下肢短缩进行纠正。结果:15例短缩2 cm以上者,有2例短缩或延长在1.5~2 cm。8例短缩在2cm以内者术后双下肢等长。根据Harris评分,优良以上73.9%(17/23),中17.3%(4/23),差8.7%(2/23)。结论:术前测量,评估,术中股骨颈恰当截骨,软组织充分松解,调整骨水泥厚度及股骨头颈假体长度等方法,可以有效成功治疗伴有下肢短缩的陈旧性股骨颈骨折与股骨头坏死。

Artificial Hip Replacement in Old Femoral Neck Fractures and the Femoral Head Osteonecrosis with Limp Length Discrepancy

Objective:To study the effect of hip replacement in old femoral neck fractures and the femoral head necrosis.Methods:To analyse and follow 23 cases of old femoral neck fractures and the femoral head necrosis with hip replacement.Evaluation of limp length discrepancy through clinical measurements and radiographic templates was done to anticipate the level of expected femoral neck cut and the level of loosing up tissue,to adjust the thickness of bone cement and the offsets of the femoral and head in order to maintain the length of the limbs during surgery.Results Results of the 15 patients with shortened limb over 2cm preoperatively,only 2 cases had limb lenth discrepancy between 1 and 2cm after surgery,of the 8 patients with shortened limb ranging 1 to 2cm preoperatively,none limb had been lengthened more than postoperatively compared with its contralateral limb.Harris hip score:excellent and good results was 73.9%,fair was 17.3%,poor was 8.7%.Conclusion The preoperative measurements,the level of the expected femoral neck cut and loosing up tissue,adjusting the thickness of bone cement,templating and intraoerative corrections are effect in treating old femoral neck fractures and the femoral head necrosis with limp length discrepancy.