全髋关节置换治疗伴有下肢短缩的陈旧性股骨颈骨折☆

背景：由于多数伴有下肢短缩的陈旧性股骨颈骨折患者经历过长期牵引或失败的内固定手术，髋部已严重骨质疏松，髋关节周围软组织及关节囊挛缩或股骨头缺血坏死，下肢短缩，临床治疗很困难。 目的：探讨全髋关节置换治疗伴有下肢短缩的陈旧性股骨颈骨折的临床疗效。方法：对35例伴有下肢短缩的陈旧性股骨颈骨折患者施行全髋关节置换。置换前股骨髁上骨牵引、双下肢和骨盆正位片X射线测量，置换中股骨颈截骨水平及软组织松解程度,调整假体头颈长度等对下肢短缩进行纠正。结果与结论：置换后6例置换前短缩3.0~4.0 cm，置换后仍然1例短缩在1.0 cm，其余5例及29例短缩在2 cm以内者置换后双下肢等长。置换后1年Harris评分较置换前明显提高(P < 0.05)。说明全髋关节置换后功能恢复快而稳定，优良率高，近期随访效果良好，是治疗伴有下肢短缩的陈旧性股骨颈骨折有效方法。 

Total hip arthroplasty for the treatment of old femoral neck fractures with lower limb length discrepancy

BACKGROUND: Most femoral neck fracture patients with lower limb length discrepancy have experienced long-term traction or failure internal fixation, the hip has severe osteoporosis, soft tissues around the hip joint and joint capsules contracture or avascular necrosis as well as the lower limb length discrepancy, so the clinical treatment is difficult. OBJECTIVE: To explore the clinical effect of total hip arthroplasty for treatment of old femoral neck fracture complicated with limp length discrepancy. METHODS: Thirty-five cases of old femoral neck fractures with lower limb length discrepancy were treated with total hip arthroplasty. Skeletal traction on the femoral condyle and the X-ray measurement of both lower extremities and pelvis were prepared preoperatively, it was done to anticipate for the level of femoral neck osteotomy and the level of loosing up tissue around hip joint, as well as to adjust the length of the prosthesis head and neck in order to maintain the length of the limbs during surgery. RESULTS AND CONCLUSION: Results of the 6 patients with shortened limb ranging 3.0-4.0 cm preoperartively, only 1 case had limb length discrepancy in 1 cm after surgery, as for the rest 5 cases and 29 patients with shortened limb ranging 1 to 2 cm preoperatively, none limb had been shortened postoperatively compared with its contralateral limb. According to Harris score system, the mean preoperative Harris score was significantly improved after 1 year postoperatively (P < 0.05). Total hip replacement can recover hip function rapidly and steady with a high good rate and satisfactory short term effect. Therefore, total hip arthroplasty is a very important and an effective treatment method for old femoral neck fracture with limp length discrepancy．