后外侧切口人工全髋置换术中缝合外旋肌和保留关节囊对髋关节功能恢复的影响研究

Effects of external rotator repair and capsule preservation on postoperative functions of the hip after total hip arthroplasty by postero-lateral approach

目的探讨后外侧切口人工全髋关节置换(total hip arthroplasty,THA)术中缝合外旋肌和保留后方关节囊对髋关节功能恢复的影响。方法选取我院2013年6月至2016年1月收治的80例经后外侧切口行THA的患者,根据手术方式分为治疗组和对照组,每组各40例。治疗组采用保留修复后方关节囊及外旋肌术式,对照组不给予保留修复后方关节囊。分析并比较两组术后引流量,手术时间和切口长度,血流变学指标变化;采用Harris评分对两组手术前后髋关节功能进行评价;统计两组术后并发症发生情况和肌力情况。结果治疗组术中出血量为(220.37±37.51) ml,对照组为(228.94±36.93) ml,两组相比,差异无统计学意义(P=0.063);治疗组住院时间为(15.08±1.91)天,对照组为(15.49±2.58)天,两组相比,差异无统计学意义(P=0.057);治疗组术后引流量为(113.57±45.72) ml,少于对照组(209.68±51.97) ml,且两组相比差异有统计学意义(P=0.000);两组的手术时间和切口长度相比,差异无统计学意义(P=0.057,0.802);术后6个月治疗组和对照组的全血粘度[(4.25±1.36),(4.31±1.28) mPa·s]、血浆粘度[(1.71±0.19),(2.46±0.43)mPa·s]、红细胞比容[(37.91±2.37),(38.02±2.40)%]、红细胞刚性指数[(5.60±0.84),(5.66±0.71)]均较术前下降(P=0.000),红细胞变形指数[(0.88±0.04),(0.89±0.03)]较术前上升(P=0.000),但两组相比,差异无统计学意义(P>0.05);治疗组髋关节Harris评分优良率(70%)高于对照组(45%),且两组相比差异有统计学意义(P=0.043);治疗组术后关节脱位发生率较对照组低,有效肌力较对照组高。结论经后外侧入路行THA术中修复关节囊和外旋肌群能有效降低术后关节脱位发生率,术中出血量少,有助于髋关节功能的恢复,疗效确切,值得临床推广应用。

Objective To investigate effects of external rotator repair and capsule preservation on postoperative function recovery of the hip after total hip arthroplasty(THA)by postero-lateral approach.Methods A total of 160 patients were enrolled from June 2013 to January 2016.All patients were divided into treatment group and control group according to different surgical approaches,with 40 patients in each group.Posterior joint capsule and external rotators were preserved in the treatment group,while not in the control group.Postoperative drainage,operation time,length of the incision,changes of hemorheology,Harris score,complications and muscle strength were analyzed and compared between the two groups.Results Intraoperative blood loss was(220.37±37.51)ml in the treatment group and(228.94±36.93)ml in the control group with no significant differences between the two groups(P=0.063).Hospital stay was(15.08±1.91)days in the treatment group and(15.49±2.58)days in the control group with no statistically significant differences(P=0.057).Postoperative drainage in the treatment group(113.57±45.72 ml)was less than that in the control group(209.68±51.97 ml)with statistically significant differences between the two groups(P=0.000).No statistically significant differences were observed in the operation time and incision length between the two groups(P=0.057,0.802).Whole blood viscosity[(4.25±1.36)mPa·s,(4.31±1.28)mPa·s],plasma viscosity[(1.71±0.19)mPa·s,(2.46±0.43)mPa·s],hematocrit[(37.91±2.37)%,(38.02±2.40)%],erythrocyte rigidity index[(5.60±0.84),(5.66±0.71)]decreased(P=0.000),while erythrocyte deformation index[(0.88±0.04),(0.89±0.03)]increased(P=0.000)compared with preoperative data 6 months after surgery;no statistically significant differences were observed between the two groups(P>0.05).The excellent rate of Harris score in the treatment group(70%)was higher than that of the control group(45%)with statistically significant differences(P=0.043).The incidence of postoperative dislocation of the treatment group was lower than that of the control group,and the effective muscle strength was better than that of the control group.Conclusions External rotator repair and capsule preservation after THA by postero-lateral approach will reduce the occurrence of postoperative joint dislocation and intraoperative blood loss,which benefits the recovery of hip functions.It is worthy of clinical applications.