经后外侧入路初次行人工全髋关节置换术外旋肌群与关节囊修复对预后的影响

IMPACT OF JOINT CAPSULE REPAIR AND EXTERNAL ROTATORS SUTURE ON PROGNOSIS IN PRIMARY TOTAL HIP ARTHROPLASTY BY POSTEROLATERAL APPROACH

目的探讨经后外侧入路初次行人工全髋关节置换术(total hip arthroplasty,THA)时术中修复关节囊及外旋肌群对患者预后的影响。方法回顾分析2006年1月-2009年6月经后外侧入路初次行THA的股骨颈骨折患者159例,根据后方结构修复方式不同分为A、B、C、D 4组。4组患者性别、年龄、致伤原因、病程、骨折类型、合并内科疾病、假体选择等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。A组(n=38)术中修复关节囊与外旋肌群;B组(n=39)术中仅修复关节囊,未修复外旋肌群;C组(n=41)术中仅修复外旋肌群,未修复关节囊;D组(n=41)关节囊与外旋肌群均未修复。对各组出血量、引流量、术后早期髋关节脱位率、Harris评分以及患髋内、外旋范围等进行比较分析。结果各组手术时间、术中出血量及引流量比较差异均无统计学意义(P>0.05)。患者均获随访,随访时间12～24个月,平均21.6个月。A、B、C、D组发生术后早期髋关节脱位分别有0、0、4(9.8%)、4(9.8%)例,髋关节脱位发生率组间比较差异有统计学意义(χ2=7.910,P=0.048)。术后6周及6、12个月,各组Harris评分均较术前显著改善(P<0.05);组间比较显示,术后6周及6个月D组显著低于A、B、C组,B、C组低于A组,差异均有统计学意义(P<0.05);术后12个月各组间比较差异均无统计学意义(P>0.05)。术后6周及6、12个月,各组患髋内旋范围比较差异均无统计学意义(P>0.05);术后6周及6个月,A、C组患髋外旋范围显著大于B、D组(P<0.05)。结论 THA术中修复外旋肌群及关节囊不增加术中出血量及引流量,可降低术后早期髋关节脱位风险,提高患髋关节Harris评分并恢复其外旋功能。建议经后外侧入路行THA术中常规修复关节囊及外旋肌群。

Objective To investigate the impact of joint capsule repair and external rotators suture on the prognosis in primary total hip arthroplasty（THA） by posterolateral approach.Methods Between January 2006 and June 2009,159 patients with femoral neck fracture underwent primary THA by posterolateral approach,and were divided into 4 groups according to different treatments： joint capsule repair and external rotators suture were given in group A（n=38）,only joint capsule repair in group B（n=39）,only external rotators suture in group C（n=41）,and no joint capsule repair or external rotators suture in group D（n=41）.There was no significant difference in gender,age,cause of injure,disease duration,type of fracture,combined medical disease,or prosthesis selection among 4 groups（P0.05）.The bleeding volume,drainage,postoperative hip dislocation rate,hip Harris score,and the hip range of motion（ROM） in internal rotation and external rotation were compared.Results There was no significant difference in operative time,bleeding volume,or drainage among 4 groups（P 0.05）.Postoperative hip dislocation occurred in 0,0,4（9.8%）,and 4（9.8%） cases of groups A,B,C,and D,respectively,showing significant difference in incidence of postoperative hip dislocation among 4 groups（χ2=7.910,P=0.048）.The hip Harris scores were significantly improved after operation when compared with preoperative scores in 4 groups（P0.05）.Significant differences were found in hip Harris score at 6 weeks and 6 months after operation among 4 groups（P0.05）;group D was significantly lower than groups A,B,and C,and groups B and C were significantly lower than group A（P 0.05）.There was no significant difference in the hip ROM in internal rotation among 4 groups at 6 weeks and 6,12 months after operation（P 0.05）;but the hip ROM in external rotation were significantly bigger in groups A and C than in groups B and D at 6 weeks and 6 months after operation（P 0.05）.Conclusion Joint capsule repair and external rotators suture in primary THA by posterolateral approach do not increase the bleeding volume and drainage,but can reduce the early postoperative hip dislocation risk,increase the Harris score,and recover the external rotation function of involved hip.So joint capsule and external rotators should be repaired in THA by posterolateral approach.