陈旧性股骨颈骨折不愈合的临床病理特点和全髋关节置换术的治疗对策

目的从临床病理角度探讨全髋关节置换术（THA）治疗陈旧性股骨颈骨折不愈合的经验教训.方法 分析39例陈旧性股骨颈骨折不愈合在该院行THA患者的病例资料,通过术前和术中观察的临床病理特点,总结术前、术中和术后处理的注意事项.结果 陈旧性股骨颈骨折不愈合多具有患肢明显的短缩畸形,关节囊挛缩、肥厚,股骨上端和髋臼的骨质疏松,同侧膝关节和踝关节不同程度的功能障碍.由于患髋周围软组织挛缩,术中需进行广泛松解,手术创面大,术后渗血较多,术中应注意彻底止血.2例于术后1周内发生关节脱位,1例发生深静脉血栓,这3例并发症保守治疗均治愈.经平均3年4个月的随访,所有髋关节功能恢复良好,Harris评分优良率84.6%.结论 THA是治疗陈旧性股骨颈骨折不愈合的较为理想的方法,根据患髋周围软组织挛缩、患肢明显的短缩畸形等病理特点,术前充分准备,术中应注意彻底止血,术后早期功能锻炼是手术成功和术后取得较好疗效的关键.

The pathological characteristics and total hip replacement treatment of nonunion old-femoral-neck fracture

Objective To summarize the experience in treating the unhealed antiquated femoral neck fracture with total hip replacement as the clinical pathology was concerned. Methods A retrospective study was carried out based on the data of 39 patients with unhealed antiquated femoral neck fracture who underwent total hip arthroplasty （THA）. According to the clinical pathological characteristics which were observed preoperatively and intraopertively, the experiences of the preoperative preparation and the intraoperative as well as postoperative management were summed up. Results The unhealed antiquated femoral neck fracture presented obvious short deformity of involved limb, the contraction and hypertrophy of the articular capsule, osteoporosis of the acetabulum and upper segment of the femur, and various dysfunction of collateral knee and ankle. During the operation, the capsule needed to be extensively loosened because of the contraction of the soft tissue surrounding the involved hip joint. The assured hemostasis was strongly recommended because of the extensive operative damage. Dislocation happened in two cases within one week after the operation, and deep venous thrombosis was developed in one case. All the complications were cured. After a period of follow-up （ mean time 40 months） , all the functions of hip joint recovered and the fine rate was 84.6% based on Harris score. Conclusions Total hip replacement is an ideal approach of treating the the unhealed old femoral neck fracture. According to the general pathological appearance including the contraction of the soft tissue surrounding the involved hip joint and short deformity of the limb, seriously preoperative preparation and assured hemostasis during the operation as well as early postoperative convalescent exercise are the key paints for good curative effects.