摘要：
目的 探讨Pipkin Ⅳ型高龄髋关节后脱位一期人工关节置换术的临床应用效果.方法 自2011年8月～2016年12月选择在笔者医院诊治的Pipkin Ⅳ型高龄髋关节后脱位患者78例,按照入院顺序的单双号分为观察组与对照组各39例,手术均由同一组医生完成.观察组采用Kocher-Langenbeck入路一期行人工髋关节置换治疗,根据患者髋臼骨折情况选择人工全髋关节置换术或人工半髋关节置换术,由于患者均为高龄,多伴有骨质疏松,生物型假体骨长入差,故优先选择骨水泥型假体.对照组按照髋臼及股骨头骨折的形态、位置采用Kocher-Langenbeck入路或Smith-Peterson入路行传统切开复位方式,用重建钢板固定髋臼后壁骨折,用不等距无头加压螺钉固定股骨头骨折,记录两组预后情况.结果 观察组的手术时间、术中出血量、术后恢复时间分别为62.32±11.92min、234.10±56.20ml和2.20±0.49个月,都明显少于对照组的87.24±12.48min、289.02±45.39ml和3.33±0.39个月(P＜0.05).观察组术后1年内发生感染、内植物失效、股骨头坏死、创伤性关节炎等并发症的发生率为2.6％,对照组为25.6％,观察组术后并发症发生率明显少于对照组(P＜0.05).观察组术后1年内的髋关节功能优良率为94.9％,对照组为71.8％,观察组的髋关节功能优良率明显高于对照组(P＜0.05).结论 PipkinⅣ型高龄髋关节后脱位行一期人工关节置换术,手术时间相对短,术中创伤明显小,术后并发症较少,患者可以早期功能锻炼,尽快下地负重活动,避免患者长期卧床出现坠积性肺炎、泌尿系感染、压疮并发症,远期避免股骨头坏死、创伤性关节炎发生及二次手术的可能,有很好的应用价值.%Objective To investigate the clinical effects of the Pipkin type Ⅳ of senile hip dislocation after first stage total hip arthroplasty.Methods From August 2011 to December 2016,78 cases of patients with Pipkin type Ⅳ of senile hip dislocation after first stage total hip were selected and were equally divided into the observation group and control group of 39 cases according to the single and double numbers in order of admission.The surgery in the two groups were performed by the same group of doctors.The observation group was treated with Kocher-Langenbeck approach of first stage total hip arthroplasty,and were given the total hip arthroplasty or hemiarthroplasty by the patients with acetabular fractures,because the patients were elderly and were with osteoporosis,biological prosthesis bone ingrowth were poor,so the preferred choice was the bone cement prosthesis.The control group were given the traditional open reduction by the Kocher-Langenbeck or Smith-Peterson approach accorded to the acetabulum and femoral head fracture morphology and position,and were used with reconstruction plate for fixation of posterior wall fractures,and were used the acetabulum with unequal headless compression screw fixation of femoral head fractures,the prognosis in the two groups were recorded.Results The operation time,intraoperative bleeding volume,fracture healing time in the observation group were 62.32-± 11.92min,234.10 ± 56.20ml and 4.20 ± 1.49 months that were significantly less than the control group of 87.24 ± 12.48min,289.02 ± 45.39ml and 5.33 ± 1.39 months (P ＜ 0.05).The postoperative 1year of traumatic arthritis,infection,internal fixation failure,femoral head necrosis and complication rate in the observation group was 5.1％,so that was 25.6％ in the control group.The observation group was significantly less than the control group (P ＜ 0.05).The postoperative year of excellent and good rate of hip joint function was 94.9％ in the observation group,so that was 71.％ in the control group that the observation group was higher than that in the control group(P ＜ 0.05).Conclusion Pipkin type Ⅳ of senile hip dislocation after first stage total hip arthroplasty has relatively short time.Its intraoperative trauma was significantly smaller.It has less postoperative complications,patients with early functional exercise and weight-bearing activities as soon as possible can avoid long-term bedridden patients with hypostatic pneumonia,urinary tract infection,ulcer complications,long-term to prevent femoral head necrosis,traumatic arthritis and two surgery,so it has good application value.
