CAJ | 학술논문

目的：探讨全髋关节置换术治疗创伤性股骨头缺血性坏死的手术方法和临床疗效。方法回顾性分析自2007年1月至2011年10月安徽医科大学附属省立医院骨科行全髋关节置换术治疗的40例创伤性股骨头缺血性坏死患者，其中男31例，女9例，平均年龄49（39～65）岁。记录术前、术后Harris评分和VAS评分评价临床效果，同时术后复查X线评估假体位置。结果40例患者随访时间平均31（19～51）个月。术后切口均为Ⅰ期愈合，无假体感染、脱位以及下肢深静脉血栓形成、坐骨神经损伤等并发症发生。术后1个月及末次随访时髋关节Harris评分、VAS评分均显著优于术前（ F＝912，P＜0.05；F＝180，P＜0.05）；术后1个月与末次随访时比较除Harris 评分差异有统计学意义（P＜0.05），而VAS评分差异无统计学意义（P＞0.05）；末次随访髋关节优28例，良9例，可3例，优良率达92.5％。术后随访X线片11例骨水泥假体中1例有松动可能，29例生物型假体均为骨长入稳定，末次随访时发现2例Brooker分级Ⅰ级异位骨化病例，未予以处理。结论对于创伤性股骨头缺血性坏死经过周密的术前安排、精细的术中操作全髋关节置换术可取得良好的临床疗效，但远期效果仍需进一步观察随访。
목적：탐토전관관절치환술치료창상성고골두결혈성배사적수술방법화림상료효。방법회고성분석자2007년1월지2011년10월안휘의과대학부속성립의원골과행전관관절치환술치료적40례창상성고골두결혈성배사환자，기중남31례，녀9례，평균년령49（39～65）세。기록술전、술후Harris평분화VAS평분평개림상효과，동시술후복사X선평고가체위치。결과40례환자수방시간평균31（19～51）개월。술후절구균위Ⅰ기유합，무가체감염、탈위이급하지심정맥혈전형성、좌골신경손상등병발증발생。술후1개월급말차수방시관관절Harris평분、VAS평분균현저우우술전（ F＝912，P＜0.05；F＝180，P＜0.05）；술후1개월여말차수방시비교제Harris 평분차이유통계학의의（P＜0.05），이VAS평분차이무통계학의의（P＞0.05）；말차수방관관절우28례，량9례，가3례，우량솔체92.5％。술후수방X선편11례골수니가체중1례유송동가능，29례생물형가체균위골장입은정，말차수방시발현2례Brooker분급Ⅰ급이위골화병례，미여이처리。결론대우창상성고골두결혈성배사경과주밀적술전안배、정세적술중조작전관관절치환술가취득량호적림상료효，단원기효과잉수진일보관찰수방。
Objective To analyze the operative modalities and outcomes of total hip arthroplasty for traumatic avascular necrosis of femoral head ( ANFH).Methods A retrospective study was conducted for 40 ANFH patients undergoing total hip arthroplasty from January 2007 to October 2011.There were 31 males and 9 females with a mean age of 49 (39-65) years.Their scores of Harris hip score and visual analogue scale ( VAS ) at pre-and post-operation were recorded to evaluate the clinical outcomes and assess the location of prosthesis by radiology.Results All of them were followed for an average of 31 ( 19 -51 ) months.All incisions healed with first intention.There was no prosthetic infection , hip dislocation , deep vein thrombosis or nerve injury.The scores of Harris hip and VAS at Month 1 post-operation and the last follow-up were significantly higher than those preoperative ones (P<0.05).And the Harris hip score of the last follow-up was also significantly higher than that at Month 1 post-operation ( P<0.05 ).However , no significant difference existed in VAS score (P>0.05).The outcomes were excellent (n=28), good (n=9) and fair (n=3) with an excellent and good rate of 92.5%.Possible loosing occurred in 1/11 cemented cases while bone stability was achieved in all 29 cementless cases.And 2 case had Brooker type Ⅰheterotopic bone without treatment.Conclusion Total hip arthroplasty for traumatic ANFH can achieve satisfactory clinical efficacies with careful preoperative planning and intraoperative precision.