全髋置换术中两种关节囊处理方法疗效比较

Comparison on the clinical efficacy of two kinds of articular capsule treatment in total hip arthroplsty

目的探讨全髋置换术中两种关节囊处理方法疗效的差异,为临床医生改进手术方式提供依据,降低后外侧入路脱位的发生率。方法将60例(60髋)老年股骨颈骨折患者随机分为关节囊修复组(A组)和未修复组(B组),每组30例(30髋),A组将关节囊缝合至大粗隆骨质,B组切开关节囊后不予修复。在术后6周对两组患者的髋关节进行功能、X线及B超评估,了解患髋功能及疼痛情况以及修复的关节囊有无撕裂和未修复的关节囊有无疤痕组织形成。结果两组患者的Harris评分和VAS评分差异均无统计学意义(P>0.05),均不需扶拐行走。所有病例术后均未出现脱位,均对手术结果表示很满意。A组27例关节囊修复成功,3例修复失败;B组16例见疤痕组织形成,14例未见疤痕组织。A、B两组关节囊完整率比较差异具有统计学意义(P<0.05)。结论老年股骨颈骨折患者行全髋关节置换术时建议修复关节囊。

Objective To explore the clinical efficacy of two kinds of articular capsule treatments in total hip arthroplsty （THA） for aged patients with femoral neck fracture, to provide reference for the improvemt of surgical approach, and to reduce the incidence of dislocation by posterolateral approach. Methods Sixty patients with femoral neck fracture （60 hips） were randomly assigned into two groups, group A and group B, with 30 cases in each group （30 hips）. Capsule was reattached to the posterior edge of femoral greater trochanter in group A, and capsule was split but not repaired in group B. Functional assessment, X-ray evaluation and ultrasonography was performed 6 weeks after operation. Results There was no difference in Harris hip score or VAS. No patient used any kind of walking support. No dislocation happened. All cases expressed satisfaction with the outcome. In group A, successful repair of articular capsule was achived in 27 cases and fail happened in 3 cases. In group B, scar tissue was observed in 16 cases, while no scar tissue occurred in 14 cases. There was significant difference in integrity rate of articular capsule between group A and group B （P〈0.05）. Conclusion Repairing joint capsule is recommended in THA in aged patients with femoral neck fracture.