长柄非骨水泥全髋关节置换治疗股骨头缺血性坏死后伴股骨近端骨折的早期疗效评估

目的：探讨长柄非骨水泥全髋关节置换治疗股骨头缺血性坏死伴股骨近端骨折的早期临床效果。方法：2001年-2008年利用长柄非骨水泥全髋关节置换治疗股骨头缺血性坏死后伴股骨近端骨折患者。年龄47～59岁，平均年龄53．7岁。男21例、女3例；激素性股骨头坏死3例、酒精性股骨头坏死21例。ARCO III C期6例、Ⅳ期18例。术后影像及临床随访，观察假体位置及周围骨质情况，并进行Harris评分，从而进行疗效评价。结果：手术时间90～130min，平均115min，手术出血量400700mL，平均570mL。患者术后均获随访，随访时间为4年至7年。术后3～4月X线片示骨折愈合良好。末次随访，患者Harris评分，优15例，良6例，可3例。截至末次随访时，无1例患者出现骨溶解及假体松动，患者Harris评分从术前平均（36．1±6．O）分，提高到末次随访时平均（90．6±4．9）分。结论：长柄非骨水泥全髋置换治疗股骨头缺血性坏死后伴股骨近端骨折早期效果良好，是一种可行的治疗方法。但长期效果仍需进一步观察。

Early Evaluation of Osteonecrosis of the Femoral Head with Proximal Femoral Fracture treated by Total Hip Arthroplasty with Long-stem Uncemented Prosthesis

Objective：To discuss the early clinical effect of total hip arthroplasty （THA） with long-stem uncemented prosthesis in the treatment of osteonecrosis of the femoral head with proximal femoral fracture. Metbods：Twenty-four patients, including 21 males and 3 females, whose mean age was 53.7 years, with osteonecrosis of the femoral head and proximal femoral fracture induced by steroid （3 cases） and alcohol （21 cases）, were treated by THA with long-stem uncemented prosthesis. The clinical effect was evaluated by postoperative imaging as well as Harris Hip Score. Results： All fractures were healed 3 to 4 months after surgery. There was no case of osteolysis or prosthesis loosening at the end of follow-up （4- 7years）. Harris Hip Score changed from （36.1±6.0） （25-53） points before the surgery to （90.6±4.9） （78-98） points at the time of final follow-up, which revealed excellent results in 15 cases, good in 6 cases, and fair in 3 cases. Conclusion： THA with long-stem uncemented prosthesis is an effective method in treating osteonecrosis of the femoral head with proxi- mal femoral fracture. However, the long-term effect should be further explored.