终末髋病伴陈旧性粗隆下骨折加长柄全髋置换术△

Long-stem femoral component used in total hip arthroplasty for end-stage hip arthropathy complicated with old subtro⁃ chanteric fracture

摘要:

［目的］ 介绍终末髋病伴陈旧性股骨粗隆下骨折加长生物柄全髋置换术的手术技术和临床效果。［方法］ 2021 年本科收治 1 例终末期股骨头坏死合并陈旧性股骨粗隆下骨折患者，采用远端固定型加长生物柄行人工全髋关节置换术 （total hip arthroplasty, THA）治疗。全麻后取后外侧入路，二次截骨法取出股骨头，先置换髋臼侧，再暴露股骨粗隆下骨折端，复位后采用钢板及钢丝临时固定骨折端，加长生物柄置入后取出钢板及远端钢丝，近端钢丝加压固定骨折。［结果］ 患者顺利接受手术，术后影像显示髋关节假体位置良好。术后 1 周即可扶助行器自行下地活动，左髋关节 Harris 评分 77 分，疗效满意。［结论］加长生物柄全髋关节置换术是治疗终末髋病伴陈旧性股骨粗隆下骨折的有效方法。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical outcome of total hip arthroplasty with long-stem cementless femoral component for end-stage hip arthropathy complicated with old subtrochanteric fracture. [Methods] In 2021, a patient with end-stage femoral head necrosis combined with old subtrochanteric fracture was admitted to our department and received total hip ar- throplasty (THA) with long-stem cementless femoral component. The femoral head was removed through the posterolateral approach under general anesthesia, and the acetabular component was placed firstly, and then the subtrochanteric fracture ends was exposed by lengthening the incision distally. After reduction, the fracture end was temporarily fixed with steel plate and cerclage wires. Finally, the long-stem ce- mentless femoral component was inserted in place to fix the fracture, subsequently, the head component was inserted, the hip was reduced and the incision was sutured in layers. [Results] The patient underwent the operation successfully with the hip prostheses in good position on radiographs. One week after operation, the patient was able to walk himself with an assistant device. The Harris score of the left hip was marked as 77, which was satisfactory curative effect. [Conclusion] This total hip arthroplasty with long-stem cementless femoral compo- nent proves effective treatment for end-stage hip arthropathy complicated with old subtrochanteric fracture.