全髋关节置换术治疗髋臼骨折继发创伤性髋关节炎和股骨头坏死的远期效果

闫亮　吕守正

摘要：目的  觀察全髋关节置换术治疗髋臼骨折继发创伤性髋关节炎和股骨头坏死中远期疗效。方法  选取2015年1月～2019年9月在我院行全髋关节置换术治疗的患者125例，其中65例髋臼骨折继发创伤性髋关节炎患者设为观察组，60例股骨头坏死患者设为对照组，比较两组临床优良率、手术指标（手术时间、术后引流量、围术期输血量）、治疗前后髋关节Harris评分以及术后并发症发生情况。结果  观察组临床治疗优良率为83.07%，低于对照组的93.33%，差异有统计学意义（P<0.05）;观察组手术时间、术后引流量、围术期输血量均大于对照组，差异有统计学意义（P<0.05）;治疗后两组Harris评分均高于治疗前，但观察组Harris评分低于对照组，差异无统计学意义（P>0.05）;观察组并发症发生率为21.53%，高于对照组的13.33%，差异有统计学意义（P<0.05）。结论  全髋关节置换术治疗股骨头坏死中远期疗效、并发症发生率及手术指标方面优于髋臼骨折继发创伤性髋关节炎，但术后髋关节功能恢复效果基本一致，相比全髋关节置换术更适用于股骨头坏死治疗。

关键词：全髋关节置换术;髋臼骨折;髋关节炎;股骨头坏死

中图分类号：R687.4                                 文献标识码：A                                 DOI：10.3969/j.issn.1006-1959.2020.14.031

文章编号：1006-1959（2020）14-0105-03

Medium and Long-term Effects of Total Hip Arthroplasty in the Treatment of Traumatic Hip

Arthritis and Femoral Head Necrosis Secondary to Acetabular Fractures

YAN Liang，LYU Shou-zheng

（Spine and Joint Surgery，Baodi Clinical College，Tianjin Medical University，Tianjin 301800，China）

Abstract：Objective  To observe the medium- and long-term effects of total hip arthroplasty in the treatment of traumatic hip arthritis and femoral head necrosis secondary to acetabular fractures.Methods  A total of 125 patients who underwent total hip arthroplasty in our hospital from January 2015 to September 2019 were selected， of which 65 patients with acetabular fracture secondary to traumatic hip arthritis were set as the observation group， and 60 patients with femoral head necrosis the patients were set as the control group， and the clinical excellent rate， surgical indicators （operation time， postoperative drainage volume， perioperative blood transfusion volume）， Harris score before and after treatment， and postoperative complications were compared between the two groups.Results  The excellent rate of clinical treatment in the observation group was 83.07%， lower than 93.33% in the control group， the difference was statistically significant （P<0.05）;The operation time， postoperative drainage volume， and perioperative blood transfusion volume of the observation group were all greater than that of the control group，the difference was statistically significant （P<0.05）; the Harris score of both groups after treatment was higher than before treatment， but the Harris score of the observation group was lower than In the control group， the difference was not statistically significant （P>0.05）; the complication rate of the observation group was 21.53%， higher than the control groups 13.33%， the difference was statistically significant （P<0.05）.Conclusion  Total hip replacement surgery is superior to acetabular fracture secondary to traumatic hip arthritis in terms of mid- and long-term efficacy， incidence of complications， and surgical indicators for the treatment of femoral head necrosis. Hip replacement surgery is more suitable for the treatment of femoral head necrosis.

Key words：Total hip replacement;Acetabular fracture;Hip arthritis;Femoral head necrosis

髋臼骨折（acetabular fracture）是常见骨盆骨折类型，且与创伤有关，多伴有创伤引起髋关节脱   位[1]。由于髋臼骨折类型不同、骨折块移位程度不同以及初次骨折手术复位效果不同，远期容易并发症不同程度创伤性髋关节炎和股骨头坏死[2]。目前，临床多采用全髋关节置换术治疗髋臼骨折继发创伤性髋关节炎和股骨頭坏死，但是关于临床治疗中远期效果仍存在争议[3]。本研究结合2015年9月～2019年9月我院诊治的65例髋臼骨折继发创伤性髋关节炎和60例股骨头坏死患者为研究对象，比较全髋关节置换术治疗髋臼骨折继发创伤性髋关节炎和股骨头坏死中远期疗效，为临床的有效治疗提供一定参考依据，现报道如下。

1资料与方法

1.1一般资料  选取2015年9月～2019年9月天津医科大学宝坻临床学院脊柱关节外科诊治的65例髋臼骨折继发创伤性髋关节炎为观察组，60例股骨头坏死患者为对照组。……