生物型加长柄全髋关节置换治疗转子下骨折合并股骨头坏死的疗效

目的探讨使用生物型加长柄行全髋关节置换治疗股骨转子下骨折合并股骨头缺血性坏死的可行性及临床疗效。方法回顾性分析2016年1月至2020年1月收治的88位患者,其中30例股骨转子下骨折合并股骨头缺血性坏死行I期生物型加长柄关节置换(实验组),20例单纯转子下骨折组行PFNA内固定术(PFNA组),32例单纯股骨头缺血性坏死行人工关节置换术(关节置换组),比较3组的手术时间、围术期出血量、术后住院天数;比较实验组与PFNA组骨折愈合时间;比较实验组与关节置换组术后1,3,6月和末次随访的髋关节Harris评分。结果实验组手术时间高于PFNA组及关节置换组,差异有统计学意义(P <0.05);3组围术期出血量、术后下地活动时间及住院天数,差异有统计学意义(P <0.05);实验组与PFNA组骨折愈合时间,差异无统计学意义,实验组与关节置换组术后髋关节Harris评分,差异无统计学意义(P <0.05)。结论生物型加长柄I期行全髋关节置换治疗股骨转子下骨折合并股骨头缺血性坏死可取得良好的临床疗效,骨折愈合时间与PFNA术无明显差异。

The Currative Effect of Biological Lengthened Handle Total Hip Arthroplasty in the Treatment of Subtrochanteric Fracture Combined with Femoral Head Necrosis

  Objective   To investigate the feasibility and clinical effect of total hip replacement with the biologically lengthened stem in the treatment of subtrochanteric fractures combined with the necrosis of femoral head.   Methods   A total of 88 patients admitted from January 2016 to January 2020 were analyzed retrospectively. Among them, 30 cases of subtrochanteric fractures with the avascular necrosis of the femoral head underwent stage I biotype long-stem joint replacement （experimental group）, 20 cases of simple subtrochanteric fracture group underwent PFNA internal fixation （PFNA group）, and 32 cases of simple avascular necrosis of the femoral head underwent the artificial joint replacement （joint replacement group）. The operation time, perioperative blood loss and postoperative hospitalization were compared among the three groupsand the fracture healing time between the experimental group and the PFNA group was compared so as to compare the hip Harris scores of the experimental group and the joint replacement group 1, 3, 6 months after the surgery and the last follow-up.   Results   The operation time of the experimental group was higher than those of the PFNA group and the joint replacement group, and the difference was statistically significant; The three groups had the statistically significant differences in perioperative blood loss, time of postoperative activities and the length of hospital stay; There was no significant difference in fracture healing time between the experimental group and the PFNA group and there was no statistically significant difference in the Harris score of the hip joint between the experimental group and the joint replacement group.   Conclusion  The total hip arthroplasty for the treatment of subtrochanteric fractures with the necrosis of femoral head can achieve good clinical results. There is no significant difference between fracture healing time and PFNA surgery.