髋臼骨折内固定术后的全髋关节置换

目的探讨髋臼骨折经内固定术后出现并发症而导致疗效不佳,行全髋关节置换(TH R)的方法和疗效。方法总结经切开复位内固定治疗的髋臼骨折患者11例,因术后27～63个月(平均46.5个月)内继发创伤性关节炎或股骨头坏死,继而行全髋关节置换术。其中合并髋臼骨缺损6例,进行颗粒性植骨2例,结构性加颗粒性植骨4例;异位骨化4例,均发生于K-L入路。采用后外侧入路9例,髂股延伸切口2例,其中6例为原手术切口。结果11例患者全部得到随访,随访1年6个月～7年3个月,平均3年5个月。出现感染1例,脱位1例,无菌松动1例。术后再次异位骨化2例,其中1例引起坐骨神经症状,再次行神经松解术。所有随访病例髋关节功能均有改善,H arris评分由术前平均47分,提高到术后88分。结论选择正确的手术入路,适当处理异位骨化组织和内固定物,重建髋臼骨缺损,是髋臼骨折经切开复位内固定术后,再行全髋关节置换成功的关键。

Total hip replacement after operative treatment of acetabular fracture

Objective To discuss the methods and results of total hip replacem ent after operative treatment for acetabular fractures. Methods 11 cases of prim ary total hip arthroplasty were performed to treat post-traumatic osteoarthrosi s and avascular necrosis of the femoral head that had developed following open r eduction and internal fixation for acetabular fractures. The average duration fr om the operative treatment of acetabular fractures to the total hip arthroplasty was 46.5 months (ranging from 27 months to 63 months). 6 of the 11 cases had ac etabular bone defects. 2 of them were reconstructed with morselled bone grafting , and the other 4 cases were reconstructed with structural bone grafting and mor selled bone grafting. Heterotopic ossification occurred all in the K-L approach in 4 cases. Results All the 11 cases were followed up for an average time of 3 years and 5 months (ranging from 1 years and 6 months to 7 years 3 months). Post operative infection occurred in 1 case, dislocation in 1case, and aseptic loosen ing of acetabulum in 1 case. Heterotopic ossification recurred in 2 of the 4 for mer cases of heterotopic ossification after total hip replacement. And 1 of the 2 had to undergo neurolysis because of severe pain of sciatic nerve. The hip joi nt function was reported to be improved obviously after operation in all the pat ients followed up. Harris scoring improved from 47 points preoperatively to 88 p oints postoperatively. Conclusion Reasonable surgical approach, proper managemen t of heterotopic ossification and retained hardware, and reconstruction of aceta bular bone deficiency are essential to a good outcome of total hip replacement a fter operative treatment of acetabular fractures.