小儿麻痹症后遗症并发股骨颈骨折的手术方法探讨
摘要
目的探讨小儿麻痹症后遗症并发股骨颈骨折的特点及手术治疗方式选择。方法回顾性分析自2012-02—2017-05诊治的5例小儿麻痹症后遗症并发股骨颈骨折,2例行闭合复位空心钉内固定术,2例行人工股骨头置换术,1例行全髋关节置换术。结果 1例闭合复位空心钉内固定术后1年髋关节功能Harris评分为85分,随访期间未见明显并发症发生。1例闭合复位空心钉内固定术后随访3年,髋关节功能Harris评分为82分。1例人工股骨头置换术后随访2年,髋关节功能Harris评分79分;患者左髋部出现弹响,X线片未显示假体松动,考虑髂胫束撞击综合征。1例人工股骨头置换术后随访5年,髋关节功能Harris评分78分。1例全髋关节置换术后3个月髋关节功能Harris评分为85分,患者恢复良好。结论小儿麻痹症后遗症并发股骨颈骨折多发生于萎缩侧,骨折移位不明显者可选择内固定治疗,骨折移位明显者选择人工髋关节置换术治疗,需根据患肢外展肌力、股骨近段髓腔情况选择合适的假体类型。
引文
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[11]Mac Kenzie JR,Kelley SS,Johnston RC.Total hip replacement for coxarthrosis secondary to congenital dysplasia and dislocation of the hip.Long-term results[J].J Bone Joint Surg Am,1996,78(1):55-61.
[2]Haziza M,Kremer R,Benedetti A,et al.Osteoporosis in a postpolio clinic population[J].Arch Phys Med Rehabil,2007,88(8):1030-1035.
[3]Bickerstaffe A,Beelen A,Nollet F.Circumstances and consequences of falls in polio survivors[J].J Rehabil Med,2010,42(10):908-915.
[4]Chang KH,Lai CH,Chen SC,et al.Femoral neck bone mineral density in ambulatory men with poliomyelitis[J].Osteoporos Int,2011,22(1):195-200.
[5]Moyer-Mileur LJ,Dixon SB,Quick JL,et al.Bone mineral acquisition in adolescents with type 1 diabetes[J].J Pediatr,2004,145(5):662-669.
[6]Silver JK,Aiello DD.Polio survivors:falls and subsequent injuries[J].Am J Phys Med Rehabil,2002,81(8):567-570.
[7]Genet F,Schnitzler A,Mathieu S,et al.Orthotic devices and gait in polio patients[J].Ann Phys Rehabil Med,2010,53(1):51-59.
[8]柴伟,任鹏,陈继营.股骨颈骨折的治疗[J].中国临床医生,2013,41(11):74-76.
[9]Yoon BH,Lee YK,Yoo JJ,et al.Total hip arthroplasty performed in patients with residual poliomyelitis:does it work?[J].Clin Orthop Relat Res,2014,472(3):933-940.
[10]Phillips CB,Barrett JA,Losina E,et al.Incidence rates of dislocation,pulmonary embolism,and deep infection during the first six months after elective total hip replacement[J].J Bone Joint Surg Am,2003,85(1):20-26.
[11]Mac Kenzie JR,Kelley SS,Johnston RC.Total hip replacement for coxarthrosis secondary to congenital dysplasia and dislocation of the hip.Long-term results[J].J Bone Joint Surg Am,1996,78(1):55-61.