全髋关节置换术关节囊保留与否临床对比研究

Comparative research of whether or not to reserve articular capsule in total hip arthroplasty

目的比较老年股骨颈骨折患者接受全髋关节置换术（THA）关节囊保留与否的临床疗效。方法回顾性分析2009年1月至2012年12月经后外侧人路初次THA治疗老年单侧股骨颈骨折患者140例，按是否修复关节囊及放置引流分为两组，其中保留关节囊不放置引流组（A组）78例，小保留关节囊放置引流组（B组）62例，两组患者性别、年龄、术前并发症等一般资料具有可比性（P〉0．05）。评价比较两组患者术前和术后6个月Harris髋关节功能评分、术前和术后24h血红蛋白值、术前至术后24h血红蛋白变化、术中出血量、手术时间、术后引流量、术后早期髋关节脱位率、换药次数、术后感染率、下地活动时间和住院时间。结果术后140例患者均获得随访6～9个月，平均7．2个月。两组患者伤口愈合均良好。B组患者术后引流量平均为267．74±2．71ml。两组患者术前皿红蛋白值、手术时间、术前和术后6个月Harris髋关节功能评分、术后感染之差异，无统计学意义（P〉0．05）；A组和B组患者术后24hml红蛋白值（103．00±10．34g／LXq95．17±8．32g／L）、术前至术后24h血红蛋白变化值（24．38±8．02g／L至35．30±10．00g／L）、术中出血量（301．03±3．55ml对343．23±4．98ml）、术后髋关节脱位（1．3％对9．7％）、换药次数（4．17±1．03次对6．43±0．87次）、下地活动时间（4．70±1．14d对6．50±0．91d）和住院时间（12．52±1．86d对16．87±2．45d）之差异，有统计学意义（P〈0．05）。结论保留关节囊、不放置引流的rrHA不增加手术操作时间和术后感染率，能够减少术中出血和早期髋关节脱位风险，使患者早期下床活动，缩短住院时间。

Objective Ib compare the effects of whether or not to reserve articular capsule in elderly patients with unilateral femoral neck fracture in primary total hip arthroplasty （THA）. Methods From january 2009 to December 2012, 140 patients with unilateral femoral neck fracture underwent primary THA through posterolateral approach were analyzed retrospectively. All of them were divided into 2 groups accoMing to whether or nol to reserve articular capsule and place drainage. Seventy-eight cases were reserved articular capsule and without placed drainage in Group A, and 62 cases without reserved articular capsule but placed drainage were in Group I5. There was no significant difference in gender, age and preoperative complications between the two groups （P〉0. 05）. The comparative items among two groups included preoperative and postoperative 6 months Harris hip score, preoperative and postoperative 24 hours hemoglobin value, change of hemoglobin value from preoperative to postoperative 24 hours, intraoperative blood loss, operative time, drainage rate, postoperative hip dislocation, frequency of dressing change, postoperative infection, leaving bed time and hospital stay. Results All patients were followed up from 6 to 9 months, an average of 7. 2 months. The patients in Group B had the average drainage rate of 267.74± 2.71 ml. There were no significant differences of preoperative hemoglobin value, operative time, preoperative and stoperative 6 months Harris hip score and postoperative infection between two groups （P〉0. 05）. Signifieam differences were found among groups A and groups B for the postoperative 24 h hemoglobin value （ 103.00 ± 10. 34 g/L. vs 95.17 ± 8.32 g/L）. change of hemoglobin value from preoperative to postoperative 24 hours （24.38 ± 8.02 g/L to 35.30 ± 10.00 g/L）, intraoperative blood loss （301. 03 ± 3.55 ml vs 343.23 ± 4.98 ml）, rate of early hip dislocation （1.3% vs 9.7% ）, frequency of dressing change （4. 17 ± 1.03 vs 6. 43 ± 0. 87）, leaving bed time （4. 70 ± 1.14 d vs 6. 50 ± 0. 91 d）, hospital stay （12. 52 ± 1. S6 d vs 16. 87 ± 2. 45 d） （P〈0.05）. Conclusions Retaining articular capsule not placed drainage alter THA is not increase the operation time and postoperative infection, which can reduce the patient＇ s blood loss and risk of early hip dislocation, to make patients early ambulation, shorten hospitalization time.