髋臼有限加深、全髋置换术治疗股骨颈骨折、严重股骨头缺血性坏死伴髋关节骨性关节炎

目的探讨髋臼有限加深、全髋置换术结合软组织松解、骨创治疗仪治疗成人股骨颈骨折及严重股骨头缺血性坏死伴髋关节骨性关节炎的近期疗效。方法对38例41髋成人股骨颈骨折、股骨头坏死、髋关节骨性关节炎患者实施了髋臼有限加深法非骨水泥假体全髋置换术并结合软组织松解、骨创治疗仪治疗。结果经术后6个月至5年6个月的随访,所有病人患髋疼痛消失,可以长时间行走,X线片示人工髋关节位置良好,假体无松动及明显下沉迹象,生活自理并恢复日常工作。Harris评分由术前(15.16±1.12)分恢复到术后的(92.42±1.08)分,差异均有统计学意义(P0.01)。结论髋臼有限加深法全髋置换术结合软组织松解、骨创治疗仪治疗成人股骨颈骨折、股骨头坏死、髋关节骨性关节炎,明显提高了髋臼假体的稳定性,可预防髋臼包容不佳导致髋臼假体不稳,近期疗效优良,值得推广应用。

Acetabular finite deepening followed by total hip replacement in the treatment of femoral neck fractures and severe ischemic necrosis of the femoral head accompanying osteoarthritis

Objective To explore the short-term effects of total hip arthroplasty combined with acetabular finite deepening,soft tissue release and bone wound therapy in the treatment of adult femoral neck fractures and severe ischemic necrosis of the femoral head accompanying hip osteoarthritis. Methods From January 2007 to January 2014,41 hips in 38 patients of adult femoral neck fractures,avascular necrosis of the femoral head combined with hip osteoarthritis underwent acetabular finite deepening,total hip arthroplasty using non cement prosthesis,soft tissue release,along with the use of bone wound therapeutic instrument,including 28 males,10 females; aged 24 to 102 years old,with an average age of 65 years; 3 cases of bilateral lesions,35 cases of unilateral lesion. The Harris scores were measured for statistical analysis and evaluation of curative effect before and after surgery. The data were analyzed by paired-sample t test with SPSS10. 0 software,with a statistical significance when P 〈 0. 05. Results The follow-up period ranged from6 months to 5 years,averaging 2 years and 6 months. Hip pain disappeared in all cases,which regained the abilityof long walk,self care and daily work. The X ray showed well positioned artificial hip joint,without obvious signs of prosthesis loosening and sinking. The Harris scores increased from 15. 16 ± 1. 12 preoperatively to 92. 42 ± 1. 08 postoperatively,with a statistically significant difference of P 〈 0. 01. Conclusion Acetabular finite deepening followed by total hip replacement,combined with soft tissue release and bone wound therapy in the treatment of adult femoral neck fracture,avascular necrosis of the femoral head and hip osteoarthritis can obviously improve the stability of the acetabular component,prevent acetabular prosthesis instability caused by poor compatibility of acetabulum,achieving good shor-term therapeutic effect,worthy of clinical popularization and application.