全髋关节置换和全髋关节表面置换治疗髋臼骨折术后继发性创伤性关节炎患者的临床对比分析
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摘要
目的对比全髋关节置换(THR)和全髋关节表面置换(HRA)治疗髋臼骨折术后继发性创伤性关节炎的临床疗效。方法我院收治的42例髋臼骨折术后继发性创伤性关节炎患者,据治疗方式不同分为HRA组和THR组各21例。比较两组后髋关节评分(Harris)、髋关节活动度、并发症发生率。结果两组术后1月、3年Harris评分较术前明显提高(P <0. 05),但两组间比较,差异无统计学意义(P> 0. 05)。HRA组优10例,良6例,优良率72. 72%,THR组优8例,良7例,优良率75. 00%。两组术后3年髋关节外展、屈曲、内旋、内收、外旋均较术前升高(P <0. 05),但两组间比较,差异无统计学意义(P>0. 05)。两组术后感染率、关节脱位、血管神经损伤、深静脉血栓率比较,差异无统计学意义(P> 0. 05)。结论 THR适用于骨缺损更为严重的患者,而对于部分患者具备选用HRA进行治疗,能有效为患者保留骨量,为术后运动和生存质量有明显帮助。
Objective To compare the clinical efficacy between THR and HRA in the treatment of patients with post-traumatic arthritis after surgery of acetabular fracture.Methods The clinical data of 42 patients with post-traumatic arthritis after surgery of acetabular fracture were retrospectively analyzed.The patients were divided into total hip resurfacing group( HRA) and total hip replacement group( THR) according to different treatment methods,21 in each group.Harris scores,activity of hip joint,and incidence of complication were compared between the two groups before and after surgery.Results The Harris scores of the two groups after one month and three years of surgery were significantly higher than those before the operation( P < 0. 05).However,there was no significant difference in the Harris scores between the two groups( P > 0. 05).In the HRA group,10 cases were excellent and 6 cases were good.The excellent and good rate was 72. 72%.In the THR group,8 cases were excellent and 7 cases were good.The excellent and good rate was75. 00%.The hip abduction,flexion,internal rotation,adduction and external rotation of the two groups were significantly better than those before operation( P < 0. 05),but no significant differences were found between the two groups( P > 0. 05).There were no significant difference in incidence of postoperative infection,joint dislocation,vascular nerve injury,and deep vein thrombosis between the two groups( P > 0. 05).Conclusion THR is suitable for patients with more severe bone defects.For some patients,HRA is used to effectively preserve bone mass for patients,which is helpful for postoperative exercise and quality of life.
Objective To compare the clinical efficacy between THR and HRA in the treatment of patients with post-traumatic arthritis after surgery of acetabular fracture.Methods The clinical data of 42 patients with post-traumatic arthritis after surgery of acetabular fracture were retrospectively analyzed.The patients were divided into total hip resurfacing group( HRA) and total hip replacement group( THR) according to different treatment methods,21 in each group.Harris scores,activity of hip joint,and incidence of complication were compared between the two groups before and after surgery.Results The Harris scores of the two groups after one month and three years of surgery were significantly higher than those before the operation( P < 0. 05).However,there was no significant difference in the Harris scores between the two groups( P > 0. 05).In the HRA group,10 cases were excellent and 6 cases were good.The excellent and good rate was 72. 72%.In the THR group,8 cases were excellent and 7 cases were good.The excellent and good rate was75. 00%.The hip abduction,flexion,internal rotation,adduction and external rotation of the two groups were significantly better than those before operation( P < 0. 05),but no significant differences were found between the two groups( P > 0. 05).There were no significant difference in incidence of postoperative infection,joint dislocation,vascular nerve injury,and deep vein thrombosis between the two groups( P > 0. 05).Conclusion THR is suitable for patients with more severe bone defects.For some patients,HRA is used to effectively preserve bone mass for patients,which is helpful for postoperative exercise and quality of life.
引文
[1]安雪军,宋洁富,魏杰,等.全髋关节置换术治疗髋臼骨折内固定术后继发创伤性髋关节炎的疗效观察[J].中国骨伤,2017,30(3):233-235.
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[11]郭晓斐,舒莉,郭英,等.不同人工髋关节置换术治疗创伤性关节炎近期疗效分析[J].贵州医药,2017,41(6):635-637.
[12]刘尧,朱建荣,张迎.针对性护理干预在骨折合并糖尿病患者围手术期中的应用研究[J].保健医学研究与实践,2017,14(1):82-83.
[13]Moszczynski AJ,Hintermayer MA,Strong MJ. Phosphorylation of Threonine 175 Tau in the Induction of Tau Pathology in Amyotrophic Lateral Sclerosis—Frontotemporal Spectrum Disorder(ALS-FTSD). A Review[J]. Front Neurosci,2018,12(31):259-261.
[14]罗明月,朱冬云,陈志远,等.多排CT及重建技术检查髋臼骨折的临床应用价值[J].职业卫生与病伤,2012,27(5):286-289.
[15]邹建荣.全髋关节置换治疗髋臼骨折术后创伤性关节炎的效果分析[J].中国伤残医学,2016,24(19):27-28.
[16]陆慧杰.全髋关节置换术治疗髋臼骨折后创伤性关节炎分析[J].浙江创伤外科,2016,21(3):584-586.
[17]房学武.髋臼骨折后创伤性关节炎全髋关节置换的临床效果探讨[J].现代诊断与治疗,2017,(21):774-776.
[18]高靖宇.髋臼骨折术后并发创伤性关节炎患者用全髋关节置换术进行治疗的效果探析[J].当代医药论丛,2017,15(1):58-59.
[19]聂志刚,彭昊,方洪松,et al.髋臼骨折术后并发创伤性关节炎的影响因素分析[J].实用骨科杂志,2018,24(5):19-24.
[20]孙卫国,孙相福,杨德文,等.经K-L入路用于髋臼骨折患者治疗中的临床效果[J].临床医药文献电子杂志,2017,4(42):8169-8169.
[21]马晓飞,涂杨茂.前路钛板加方形区螺钉联合改良后柱螺钉治疗复杂髋臼骨折临床观察[J].解放军医药杂志,2017,29(10):46-49.
[22]郎荣华.人工髋关节置换术治疗髋臼骨折继发创伤性关节炎的疗效观察[J].当代医学,2017,23(33):76-78.
[23]尹乾斌.全髋关节置换治疗髋臼骨折术后关节病变[J].中国矫形外科杂志,26(15):1355-1359.
[24]田可为,陈柯.3D打印技术在全髋关节置换术治疗髋臼骨折并发股骨头缺血性坏死和创伤性关节炎中的应用[J].中医正骨,2017,29(3):42-44.
[25]张元勋,董伊隆,钱约男,等.影响髋臼骨折患者术后临床疗效的相关因素分析[J].浙江医学,2016,38(5):352-354.
[2]龙飞.髋臼骨折术后创伤性骨关节炎的临床治疗研究[J].医学美学美容旬刊,2015,63(4):233-233.
[3]彭凤,杨敏,杨红胜,等.低分子肝素钠联合红花注射液预防下肢骨折术后深静脉血栓形成的临床效果[J].西部医学,2017,29(8):1085-1087.
[4]夏厚纲,王丹丹.全髋关节置换术治疗髋臼骨折后创伤性关节炎的疗效观察[J].中国民康医学,2017,52(21):52-53.
[5]Amorini AM,Lazzarino G,Pietro VD,et al.Severity of experimental traumatic brain injury modulates changes in concentrations of cerebral free amino acids[J].Journal of Cellular&Molecular Medicine,2017,21(3):530-542.
[6]张永刚,刘鹏,刘列,等.累及负重区残留移位对髋臼骨折术后髋关节功能的影响[J].解放军医药杂志,2018,19(2):517-519.
[7]陈永坚,沈是铭,张坚若.髋臼骨折手术治疗58例分析[J].现代实用医学,2016,28(5):649-650.
[8]蒋帅,顾卫东,王忍,等.桥接组合式内固定系统和锁定钢板治疗锁骨骨折的效果比较[J].江苏大学学报(医学版),2018,28(3):85-87,91.
[9]张兴华.人工髋关节置换术治疗髋臼骨折继发创伤性关节炎的疗效观察[J].临床医药文献电子杂志,2016,3(6):1048-1048.
[10]黄钟炼,邱开封,陈洪江.不同髋关节置换术治疗髋臼骨折继发创伤性关节炎的术后疗效及安全性比较[J].数理医药学杂志,2016,29(7):960-961.
[11]郭晓斐,舒莉,郭英,等.不同人工髋关节置换术治疗创伤性关节炎近期疗效分析[J].贵州医药,2017,41(6):635-637.
[12]刘尧,朱建荣,张迎.针对性护理干预在骨折合并糖尿病患者围手术期中的应用研究[J].保健医学研究与实践,2017,14(1):82-83.
[13]Moszczynski AJ,Hintermayer MA,Strong MJ. Phosphorylation of Threonine 175 Tau in the Induction of Tau Pathology in Amyotrophic Lateral Sclerosis—Frontotemporal Spectrum Disorder(ALS-FTSD). A Review[J]. Front Neurosci,2018,12(31):259-261.
[14]罗明月,朱冬云,陈志远,等.多排CT及重建技术检查髋臼骨折的临床应用价值[J].职业卫生与病伤,2012,27(5):286-289.
[15]邹建荣.全髋关节置换治疗髋臼骨折术后创伤性关节炎的效果分析[J].中国伤残医学,2016,24(19):27-28.
[16]陆慧杰.全髋关节置换术治疗髋臼骨折后创伤性关节炎分析[J].浙江创伤外科,2016,21(3):584-586.
[17]房学武.髋臼骨折后创伤性关节炎全髋关节置换的临床效果探讨[J].现代诊断与治疗,2017,(21):774-776.
[18]高靖宇.髋臼骨折术后并发创伤性关节炎患者用全髋关节置换术进行治疗的效果探析[J].当代医药论丛,2017,15(1):58-59.
[19]聂志刚,彭昊,方洪松,et al.髋臼骨折术后并发创伤性关节炎的影响因素分析[J].实用骨科杂志,2018,24(5):19-24.
[20]孙卫国,孙相福,杨德文,等.经K-L入路用于髋臼骨折患者治疗中的临床效果[J].临床医药文献电子杂志,2017,4(42):8169-8169.
[21]马晓飞,涂杨茂.前路钛板加方形区螺钉联合改良后柱螺钉治疗复杂髋臼骨折临床观察[J].解放军医药杂志,2017,29(10):46-49.
[22]郎荣华.人工髋关节置换术治疗髋臼骨折继发创伤性关节炎的疗效观察[J].当代医学,2017,23(33):76-78.
[23]尹乾斌.全髋关节置换治疗髋臼骨折术后关节病变[J].中国矫形外科杂志,26(15):1355-1359.
[24]田可为,陈柯.3D打印技术在全髋关节置换术治疗髋臼骨折并发股骨头缺血性坏死和创伤性关节炎中的应用[J].中医正骨,2017,29(3):42-44.
[25]张元勋,董伊隆,钱约男,等.影响髋臼骨折患者术后临床疗效的相关因素分析[J].浙江医学,2016,38(5):352-354.