髋臼骨折后关节炎的保留内固定物全髋置换△

Total hip arthroplasty with retaining previous implants for traumatic arthritis secondary to acetabular fractures

摘要:

［目的］ 评价保留内固定物全髋置换（total hip arthroplasty, THA） 治疗髋臼骨折内固定后创伤性关节炎的临床疗效。 ［方法］回顾性分析 2014 年 3 月—2019 年 5 月采用 THA 治疗髋臼骨折内固定后创伤性关节炎 62 例患者的临床资料，据内固定物存留情况及医患沟通结果，27 例保留原有内固定物行 THA，35 例去除原有内固定物后行 THA。比较两组围手术期、随访及影像资料。［结果］ 两组均顺利完成手术，无血管、神经损伤等并发症。保留组的手术时间、切口长度、术中失血量、输血率、术后引流量、术后下地行走时间均显著优于去除组，差异有统计学意义 （P<0.05）。早期并发症，保留组为 10/27 （37.0％），去除组为 12/35 （34.28%），两组并发症发生率比较差异无统计学意义 （P>0.05）。所有患者随访 （4.41±2.23） 年。 保留组恢复完全负重活动时间显著早于去除组（P<0.05）。术后随时间推移，两组患者的 Harris 评分和髋伸屈 ROM、髋内外旋 ROM 均显著增加 （P<0.05）；但相应各时间点两组间 Harris 评分、髋伸屈 ROM 及髋内外旋 ROM 比较差异无统计学意义 （P> 0.05）。至末次随访时，两组均未发生脱位、局部疼痛加剧，均无再次手术翻修。影像方面，末次随访两组股骨前倾角、髋臼外展角、双下肢长度差值的差异均无统计学意义（P>0.05）。［结论］对于髋臼骨折固定术后创伤性关节炎行 THA，应依据原有内固定物具体情况与患者沟通，尽量保留原有内固定，可以减少手术创伤，更有利于 THA 术后早期功能恢复。

Abstract:

[Objective] To evaluate the clinical outcomes of total hip arthroplasty (THA) for traumatic arthritis after internal fixation of acetabular fractures. [Methods] A retrospective study was done on 62 patients who underwent THA for traumatic arthritis after internal fixa- tion of acetabular fracture in our department from March 2014 to May 2019. According to the presentation of previous implants for internal fixation and doctor- patient communication results, 27 patients underwent THA with retaining the previous implants for internal fixation (the retaining group) , while the other 35 patients underwent THA after removing the original internal- fixation implants (the removing group) . The perioperative, follow-up and imaging data of the two groups were compared. [Results] All patients in both groups had opera- tion performed smoothly without neurovascular injury and other serious complications. The retaining group proved significantly superior to the removing group in terms of operation time, incision length, intraoperative blood loss, transfusion rate, postoperative drainage volume and postoperative walking time (P＜0.05) . Early complications were 10/27 (37.0%) in the retaining group, whereas 12/35 (34.28%) in the remov- ing group, which was not significantly different between the two groups (P＞0.05) . All the patients were followed up for (4.41±2.23) years on an average, and the retaining group resumed full weight-bearing activity significantly earlier than the removing group (P＜0.05) . The Harris score, hip extension-flexion and internal-external rotation range of motions (ROMs) significantly increased in both groups postoperatively compared with those preoperatively (P＜0.05) , whereas which proved not statistically significantly different between the two groups at any corresponding time points (P＞0.05) . By the last follow-up, no dislocation, local pain deterioration, and revision surgery happened in any pa- tient of both groups. Radiographically, there was no statistically significant differences in terms of femoral anteversion, acetabular abduction angle and lower limb length discrepancy between the two groups at the latest follow-up (P＞0.05) . [Conclusion] For traumatic arthritis after internal fixation of acetabular fracture, THA with retaining previous implants according to the specific situation of the original internal fixa-tion and results of doctor-patients communication, does reduce the surgical trauma, and is more conducive to the early functional recovery.