含抗生素骨水泥股骨柄与非骨水泥髋臼金属托结合全髋置换治疗中老年股骨颈骨折内固定失败19例

背景：中老年股骨颈骨折内固定失败后的治疗充满挑战性，最佳治疗方法尚未达到一致。目的：观察含抗生素骨水泥股骨柄与非骨水泥髋臼金属托组合的全髋关节置换治疗股骨颈骨折内固定失败的效果。方法：纳入股骨颈骨折内固定失败后行人工全髋关节置换患者19例，假体均为含抗生素骨水泥股骨柄与非骨水泥髋臼金属托组合的全髋关节。髋臼侧采用生物性假体压配固定，股骨侧采用带抗生素骨水泥假体固定。12例选取金属-聚乙烯承重界面，7例选取陶瓷-聚乙烯承重界面。置换后随访，定期摄片监测假体位置，并指导功能锻炼，记录髋关节功能恢复状况。结果与结论：手术时间(110±55) min，术中出血量(510±60) mL，置换后出血量(310±40) mL。切口均一期愈合，未见局部红肿，脓性渗出。双下肢畸形恢复，长度相差均小于1 cm。19例全部获得随访，随访期间所有病例均未见假体松动征象。置换后1年随访Harris髋关节评分显著高于置换前(P < 0.05)，其中优10例，良8例，中1例，差0例，优良率为94.7%。提示全髋关节置换治疗股骨颈骨折内固定失败有一定困难，采用含抗生素骨水泥股骨柄与非骨水泥髋臼金属托组合，可加强围手术期处理以及针对性的功能锻炼，患者关节疼痛以及活动度可得到明显改善。

Treatment of failed internal fixation for adult-aged femoral neck fracture with combined total hip arthroplasty with cementless cup and ontiboiotic cemented femoral stem in 19 cases

BACKGROUND: Surgical treatment of failed internal fixation for adult-aged femoral neck fracture is challenging. The optimal procedure has not been defined. OBJECTIVE: To study the effect of total hip arthroplasty with cementless cup and antibiotic cemented femoral stem in the treatment of failed internal fixation for adult-aged femoral neck fracture. METHODS: Nineteen cases with failed internal fixation for adult-aged femoral neck fracture were performed total hip arthroplasty with cementless cup and antibiotic cemented femoral stem. The surgical characteristics and results were recorded. RESULTS AND CONCLUSION: The operation time was (110±55) minutes, intra-operative blood loss was (510±60) mL, and post-operative blood loss was (310±40) mL. All the 19 cases were followed up. No implant loosening signs were found in X-ray films. The hip function was evaluated with Harris scores system, and the scores were improved postoperatively (P < 0.05). The results were graded as excellent in 10, good in 8, fair in 1 and poor in 0, and the excellent and good rate was 94.7%. Despite the technical challenges, total hip arthroplasty with cementless cup and antibiotic cemented femoral stem is effective to treat failed internal fixation for adult-aged femoral neck fracture.