| 类风湿性关节炎继发严重髋臼内陷合并股骨骨折的全髋关节置换术 |
| Total hip arthroplasty for severe acetabular invagination with femoral fracture secondary to rheumatoid arthritis |
| 投稿时间：2024-05-11 |
| DOI：10.3969/j.issn.1672-5972.2025.01.005 |
| 中文关键词: 全髋关节置换术 内固定术 类风湿性关节炎 股骨骨折 |
| 英文关键词:Total hip arthroplasty Internal fixation Rheumatoid arthritis Femoral fracture |
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| 中文摘要: |
| 目的 探讨全髋关节置换及内固定术治疗类风湿性关节炎继发严重髋臼内陷合并股骨骨折的临床效果。方法 将2017年7月至2022年9月四川省骨科医院收治的类风湿性关节炎继发严重髋臼内陷合并股骨骨折的16例患者作为研究对象，均一期行翻修柄人工全髋关节置换术联合线缆钢板内固定术。记录手术时间、术中出血量、并发症发生情况，测量术前、术后12个月股骨头的中心点至Kohler's线的距离，股骨头旋转中心的高度，并以Harris评分评估关节功能。结果 患者术后随访12 ～ 58个月，平均（31.2±3.2）个月。手术时间56 ～ 135 min，平均（76.3±8.8）min。术中出血量200 ～ 920 mL，平均（305.0±44.2）mL。术后5例患者出现并发症，术后6个月X线片示骨折均已愈合，股骨头的中心点至Kohler's线的距离术前与术后比较，差异有统计学意义（P＜0.05）；股骨头旋转中心的高度术前与术后比较，差异无统计学意义（P＞0.05）。术后12个月Harris评分较术前明显改善，差异有统计学意义（P＜0.05）。所有患者在末次随访时未出现假体松动。结论 对类风湿关节炎继发严重髋臼内陷合并股骨骨折的患者，一期采取翻修柄全髋关节置换术联合线缆钢板内固定术，可有效改善髋臼内陷，重建髋臼旋转中心，有效改善关节功能，疗效明确，是治疗该类疾病的一种理想方法。 |
| 英文摘要: |
| Objective To investigate the clinical effect of total hip arthroplasty and internal fixation in the treatment of severe acetabular invagination with femoral fracture secondary to rheumatoid arthritis.Methods All 16 cases of femoral head necrosis combined with femoral fracture treated in Sichuan Province Orthopedic Hospital from July 2017 to September 2022 were selected as the subjects of study. All patients underwent one-stage total hip arthroplasty combined with cable plate internal fixation. The operation time, intraoperative blood loss and postoperative complications were recorded. The distance from the center point of the femoral head to Kohler's line before and after surgery, as well as the height of the center of rotation of the femoral head were measured. The joint function was evaluated by the Harris score.Results Patients were followed up for 12-58 months, with an average of (31.2±3.2) months. The operation time was 56-135 min, with an average of (76.3±8.8) min. The intraoperative blood loss was 200-920 mL, with an average of (305.0±44.2) mL. Postoperative complications occurred in 5 cases. X-ray showed that all the fractures healed 6 months after operation. Comparison of distance from the center point of the femoral head to Kohler's line before and after surgery, the difference was statistically significant (P<0.05). Comparison of preoperative and postoperative height of femoral head rotation center, the difference was not statistically significant (P>0.05). The Harris score at 12 months after operation was better than that before operation, the difference was statistically significant (P<0.05). No prosthesis loosening was found in any of the patients at the last follow-up.Conclusion For patients with rheumatoid arthritis who have secondary severe acetabular dysplasia combined with femoral fractures, a one-stage revision of the total hip arthroplasty combined with cable plate internal fixation is performed. It can effectively improve acetabular dysplasia, reconstruct the acetabular rotation center, and effectively improve joint function. The efficacy is clear, making it an ideal method for treating this type of disease. |
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