38例创伤性股骨头坏死人工髋关节置换效果研究.docVIP

38例创伤性股骨头坏死人工髋关节置换效果研究【摘要】目的 探讨创伤性股骨头坏死的病因及应用全髋置换术治疗的优点。方法 回顾性分析应用全髋置换术治疗38例创伤性股骨头坏死的临床资料。结果 全髋置换术后随访5月-60月，平均34个月，根据Harris髋关节评分标准，术前平均(35.4±7.3)分，术后末次随访，优22例，良14例，中2例，优良率为94.7％。结论 暴力大小、复位质量、骨折类型均可影响创伤性股骨头坏死发生；全髋置换术治疗创伤性股骨头坏死技术成熟、疗效肯定。 【关键词】股骨头坏死；创伤；全髋置换术 Clinical analysis on the trauma-induced osteonecrosis of femoral head treated with total hip arthroplasty 【Abstract】Objective To explore the causes of the traumatic osteonecrosis of femoral head and the advantage of the total hip arthroplasty. Methods To retrospectively analyze the clinical materials of 38 patients with traumatic osteonecrosis of femoral heads treated using the total hip arthroplasty. Harris hip Scores were used to evaluate postoperative functions of the daily life and work. Results38 patients were followed up for an average of 34 months(5 to 60 months).According to Harris hip Scores,the preoprative average score was 35.4±7.3; last postoprative follow-up shows that 22 patients were excellent,14 patients were good,2 patients were fine,the rate of excellence and goodness was94.7％. ConclusionThe causes of the traumatic osteonecrosis of femoral heads were ralated with the violence,the quality of reduction and the tapes of fracture.THA is an efficient and assured method for the treatment of the traumatic osteonecrosis of femoral heads. 【Key words】osteonecrosis of femoral head;trauma;total hip arthroplasty 股骨头坏死(osteonecrosis of femoral head，ONFH)是指不同原因导致的股骨头骨髓造血细胞、骨髓脂肪细胞及骨细胞变性坏死的一种疾病。临床将其分为创伤性股骨头坏死(trauma-induced osteonecrosis of femoral head TONFH)和非创伤性股骨头坏死(non-trauma induced osteonecrosis of femoral head，NONFH)。TONFH常继发于髋部创伤,包括股骨颈骨折、股骨头骨折、髋关节脱位、髋臼骨折、股骨转子间骨折等，还有少数轻微髋关节外伤后引发的ONFH。笔者2004.7-2010.7采用人工髋关节置换治疗创伤性股骨头坏死38例，回顾性分析创伤性股骨头坏死的临床特点及治疗体会，现报告如下。 1临床资料 1.1一般资料选择2004年7月至2010年7月间，采用人工髋关节置换术治疗的创伤性股骨头坏死住院患者共38例进行回顾性分析。患者年龄32～75岁，平均50.3岁。男20例；女18例。第一次外伤手术至髋关节置换时间2-6年，股骨头坏死发现时间距第一次外伤时间20月-50月。股骨头坏死Ficat分期：Ⅱ期3例，Ⅲ期23例，Ⅳ期12例。 1.2 原发损伤诊断①股骨颈骨折25例，其中头下型10，头颈型13，经颈型2;②髋臼骨折5例，③髋关节脱位伴股骨颈骨折5例