人工全髋关节置换术治疗股骨颈骨折内固定术后股骨头缺血性坏死

目的：探讨人工全髋关节置换术治疗股骨颈骨折内固定术后股骨头缺血性坏死的疗效。方法对泸州医学院附属医院骨与关节外科32例股骨颈骨折内固定术后股骨头缺血性坏死患者行人工全髋关节置换术。患者男18例，女14 例，年龄35～62岁，平均50．6岁，左侧19例，右侧13例。手术后8～26个月确诊为股骨头缺血性坏死，平均17．1个月。人工髋关节置换时间距初次手术时间为15～48个月，平均27．2个月。股骨头缺血性坏死的X线 Ficat分期：Ⅲ期8例，Ⅳ期24例。术前改良Harris评分（40．9±9．8）分。本组患者均采用生物型人工关节。结果术后切口均Ⅰ期愈合。全部患者随访6～48个月，平均28．3个月。末次随访 Harris评分为（90．8±4．4）分，与术前比较差异有统计学意义（P＜0．05）。其中优25例，良5例，可2例，优良率93．8％。术中1例发生假体周围骨折（C型），2例出现股骨近端劈裂骨折，相应处理后骨折均愈合。随访期间未见感染、脱位、假体松动等并发症发生。结论人工髋关节置换术是治疗股骨颈骨折内固定术后股骨头缺血性坏死的有效方法。

Total hip repalcement for osteonecrosis of the femaoral head after failed internal fixation of femaoral neck fracture

Objective To explore the therapeutic effect of total hip replacement (T HR) in treating osteonecrosis of the femoral head (ONFH) after failed internal fixation of femoral neck fracture .Methods From January 2003 to June 2012 ,32 cases (19 left hips and 13 right hips) of ONFH after failed internal fixation of femoral neck fracture were treated with THR .There were 18 males and 14 females with an age range from 35 to 62 years (mean ,50 .6 years) .The ONFH was diagnosed at 8-26 months (mean ,17 .1 months) after internal fixation ;the THR were conducted 15-48 months after first surgery (mean ,27 .2 months) .According to Fi‐cat classifi cation ,there were 8 cases at stage Ⅲ and 24 cases at stage IV .The Harris score was (40 .9 ± 9 .8) .The prosthesis of bi‐ology was used .Results All wounds healed by first intention .All cases were followed up for 6-48 months (mean ,28 .3 months) . The Harris score was (90 .8 ± 4 .4) at last follow‐up ,showing significant difference when compared with the preoperative value (P<0 .05) .The hip function were excellent in 25 hips ,good in 5 hips ,fair in 2 hip ,and the excellent and good rate was 93 .8% . There were 1 cases of periprosthetic femoral fracture(type C) ,2 cases of proximal femoral splitting fractures fractures .After corre‐sponding treatment ,fracture was healed in all cases .There were no complications (infection ,loosening dislocation or subsidence , etc) .Conclusion Total hip replacement is an effective method for the treatment of ONFH after failed internal fixation of femoral neck fracture .