本文選題：髖臼骨折　切入點：股骨頭壞死　出處：《吉林大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討髖臼骨折后解剖結(jié)構(gòu)的變化,行全髖關(guān)節(jié)置換術(shù)的特點及其髖臼側(cè)的重建方法方法:自2012年1月至2016年6月期間收治入院、明確診斷為髖臼骨折后股骨頭壞死或創(chuàng)傷性關(guān)節(jié)炎進(jìn)行全髖關(guān)節(jié)置換的17例患者的臨床資料、髖臼側(cè)基本未受影響的單側(cè)股骨頭壞死行全髖關(guān)節(jié)置換的17例患者的臨床資料,將既往有髖臼骨折病史的患者分為實驗組,另一組為對照組。統(tǒng)計對照組與實驗組患者術(shù)前術(shù)后髖關(guān)節(jié)Harris評分、關(guān)節(jié)活動范圍;統(tǒng)計兩組患者的手術(shù)時間、出血量、抗生素應(yīng)用時間、術(shù)后出現(xiàn)的并發(fā)癥(術(shù)后脫位、假體感染、異位骨化、假體松動);統(tǒng)計兩組患者術(shù)前、術(shù)后患側(cè)與健側(cè)下肢長度差值(雙側(cè)小粗隆高點與髂嵴最高點連線距離);統(tǒng)計兩組患者術(shù)后患側(cè)與健側(cè)的股骨偏心距;統(tǒng)計兩組患者術(shù)前、術(shù)后旋轉(zhuǎn)中心到淚滴連線(過健側(cè)淚滴下緣與髂嵴最高點連線的平行線)的垂直距離、水平距離。結(jié)果:實驗組患者髖關(guān)節(jié)Harris評分由術(shù)前平均37.1分提高到術(shù)后末次隨訪平均83.2分;對照組患者髖關(guān)節(jié)Harris評分由術(shù)前平均40.8分提高到術(shù)后末次隨訪平均86.4分。兩組患者髖關(guān)節(jié)活動范圍在前屈、內(nèi)收、外展、旋轉(zhuǎn)方面較術(shù)前有了明顯的改善。實驗組患者平均手術(shù)時間137分鐘,術(shù)中平均出血量941 ml,抗生素應(yīng)用時間平均3天,雙下肢長度差值術(shù)后平均為5.8 mm,患側(cè)術(shù)后股骨偏心距平均42.3mm(健側(cè)為43.2mm),術(shù)后患側(cè)旋中心到淚滴連線的水平距離平均35.6 mm(健側(cè)為35.1 mm),垂直距離平均17.4 mm(健側(cè)為18.0 mm);對照組患者平均手術(shù)時間95分鐘,術(shù)中平均出血量294 ml,抗生素應(yīng)用時間平均2天,雙下肢長度差值術(shù)后平均為6.5 mm,患側(cè)術(shù)后股骨偏心距平均43.1mm(健側(cè)為42.7mm),術(shù)后患側(cè)旋轉(zhuǎn)中心到淚滴連線的水平距離平均34.1 mm(健側(cè)為34.8mm),垂直距離平均17.6 mm(健側(cè)為17.8 mm)。兩組患者術(shù)后的髖關(guān)節(jié)Harris評分、關(guān)節(jié)活動范圍較術(shù)前得到明顯提高。對照組在手術(shù)時間、出血量、抗生素應(yīng)用時間、術(shù)后出現(xiàn)的并發(fā)癥上均較實驗組少。兩組患者術(shù)后雙下肢肢體長度差值較術(shù)前減小,均有效的重建了髖關(guān)節(jié)旋轉(zhuǎn)中心。結(jié)論:1.全髖關(guān)節(jié)置換術(shù)對髖臼骨折后創(chuàng)傷性關(guān)節(jié)炎或股骨頭壞死的晚期的治療具有良好的療效。2.髖臼骨折后髖臼的解剖結(jié)構(gòu)發(fā)生變化,對髖臼解剖結(jié)構(gòu)的再認(rèn)識是手術(shù)的核心問題。3.一些髖臼骨折后的患者髖臼結(jié)構(gòu)的改變具有不可復(fù)性,保證關(guān)節(jié)置換時髖臼杯的良好覆蓋和有效支撐是需要重點關(guān)注的問題。
[Abstract]:Objective: to investigate the changes of anatomical structure after acetabular fracture, the characteristics of total hip arthroplasty and the reconstruction methods of acetabular side: from January 2012 to June 2016, the patients were admitted to hospital. Clinical data of 17 cases of total hip replacement diagnosed as osteonecrosis of femoral head or traumatic arthritis after acetabular fracture. Clinical data of 17 cases of unilateral femoral head necrosis with basically unaffected acetabular side undergoing total hip replacement. The patients with previous history of acetabular fracture were divided into experimental group and control group. The Harris score of hip joint and the range of motion of hip joint were measured before and after operation in the control group and the experimental group, and the time of operation and the amount of bleeding in the two groups were counted. The duration of antibiotic use, postoperative complications (postoperative dislocation, prosthetic infection, ectopic ossification, prosthesis loosening); The difference of leg length between the affected side and the healthy side after operation (the distance between the bilateral trochanteric height and the highest point of iliac crest); the eccentricity of femur between the affected side and the healthy side of the two groups after operation were counted; The vertical distance from the center of rotation to the line of tear drops (the parallel line between the lower edge of the tear drop and the highest point of iliac crest), Results: the Harris score of hip joint in the experimental group increased from 37.1 before operation to 83.2 at the last follow-up. The Harris score of hip joint in the control group was increased from 40.8 before operation to 86.4 at the last follow-up. The range of hip joint activity in the two groups was anterior flexion, adduction and abduction. The mean operation time was 137 minutes, the average intraoperative bleeding was 941 ml, and the mean time of antibiotic application was 3 days. The average length difference of the lower limbs was 5.8 mm, the average eccentric distance of the affected side was 42.3 mm (the healthy side was 43.2 mm), the horizontal distance from the center of circumflex to the line of tear drops was 35.6 mm (the normal side was 35.1 mm, the vertical distance was 17.4 mm (the healthy side was 18.0 mm). The average operation time of the patients in the radiation group was 95 minutes. The average intraoperative bleeding was 294 ml, and the mean time of antibiotic application was 2 days. The average length difference of the lower limbs was 6.5 mm, the average eccentric distance of the affected side was 43.1 mm (the healthy side was 42.7 mm), the horizontal distance from the center of rotation to the line of tear drops was 34.1 mm (the healthy side was 34.8 mm, the vertical distance was 17.6 mm (the healthy side was 17.8 mm). Harris score of hip joint after operation, The operation time, bleeding volume, antibiotic application time and postoperative complications in the control group were less than those in the experimental group. The difference of limb length between the two groups was decreased. Conclusion Total hip arthroplasty is effective in the treatment of traumatic arthritis or late necrosis of femoral head after acetabular fracture. Recognition of acetabular anatomical structure is the core of the operation. 3. Some patients with acetabular fracture have irreducible acetabular structure changes. It is necessary to pay attention to ensure good cover and effective support of acetabular cup during joint replacement.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.4

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