成人髋臼发育不良行全髋关节置换术中重建外旋肌群的作用

Effect of reconstructing external rotators on developmental dysplasia of hip in adults treated by total hip arthroplasty

目的探讨对成人髋臼发育不良(DDH)采用髋关节后外侧切口行全髋关节置换术(THA)时重建外旋肌群对于预防后脱位的作用。方法自2006-01—2012-06对57例(64髋)成人DDH行初次THA,术中于股骨粗隆外旋肌群附着处用克氏针钻孔,将外旋肌群用可吸收缝线缝合至股骨大粗隆(重建组)。将重建组THA术后脱位率与同期成人DDH行THA但不重建外旋肌群(对照组)55例(62髋)的脱位率进行比较分析。结果术后6个月内,重建组仅1髋(1.6%)发生术后早期脱位,对照组则有4髋(6.5%)发生早期脱位,2组髋关节早期脱位率差异有统计学意义(P<0.05)。6个月以后,2组均未发生迟发性脱位。2组末次随访时Harris评分比较,差异无统计学意义(P>0.05);但2组末次随访时Harris评分均较术前明显提高,差异有统计学意义(P<0.05)。结论采用后外侧切口对成人DDH行THA治疗时重建外旋肌群技术能够有效预防术后早期脱位。

Objective To explore the postoperative effect of reconstructing external rotators by postern-lateral approach on dislocation rate following primary total hip arthmplasty （THA） for developmental dysplasia of the Hip （DDH） in adults. Methods A total of 57 eases （64 hips） of DDH in adults treated by primary THA in our hospital from January 2006 to June 2012 were retrospectively analyzed. Four holes were drilled on greater tmchanter on the proximal femoral bone. The external rotators were sutured to the posterior part of greater troehanter using absorbing thread（reconstruction group）. The postoperative dislocation rate of this group was compared with that of the other 55 cases （62 hips） without external rotator reconstruction （control group）. Results In reconstruction group, only 1 dislocation case occurred within 6 months （1.6%）; while in control group 4 case dislocations occurred （6.5%）. The difference between the two groups was statistically significant （P 〈0.05）. However, there was no significant difference in the dislocation rate between two groups after 6 months. Also, there was no significant difference in Harris score between two groups at the last follow-up （P 〉0.05）. While the Harris score at the last follow-up of both two groups were significant higher than those before operation （P 〈0.05）. Conclusion Reconstruction of external rotators can effectively prevent early dislocation after primary THA for DDH.