重建外旋肌群对预防初次全髋关节置换后关节后脱位的评价

Evaluation of external rotators muscle reconstruction for prevention of postoperative arthrosis posterior dislocation after primary total hip arthroplasty dislocation

目的评价采用后外侧入路初次全髋关节置换，术中重建外旋肌对预防初次全髋关节置换后关节后脱位的影响。方法2007年1月—2013年3月，采用后外侧切口入路行初次全髋关节置换75例77髋，在股骨大转子后方贴近原解剖位置处钻孔将外旋肌群用7号线或是薇乔线“8”字缝合重建作为A组。同期常规初次THA未行外旋肌群止点重建的65例66髋作为B组，比较2组THA术后脱位率，最后进行比较分析。结果2组患者术后随访8～40个月。A组患者随访出现术后关节后脱位1例（约1．30％）；B组患者1例因脑梗塞未能随访，其余术后出现关节后脱位6例（约9．23％）。A组患者术后关节后脱位发生率明显低于B组（P〈0．05）。结论初次全髋关节置换术中重建外旋肌群与股骨大转子之间的完整性及连续性，有助于恢复髋关节外旋肌群肌力及降低初次行后入路全髋关节置换术后早期髋关节后脱位的发生率，增加髋关节的稳定性，从而减少患者术后并发症所引起的痛苦，减少患者住院费用和康复时间，减少对患者的生理和心理健康的影响。

Objective To evaluate the clinical effects of external rotator muscle reconstruction for prevention of postoperative arthrosis posterior dislocation with primary total hip arthroplasty through posterior lateral approach. Methods From January 2007 to March 2013,75 patients （77 hips） and other 65 patients （66 hips） of the primary total hip arthroplasty performed through posterior lateral approach were divided into group A and group B. In group A, external rotator muscle were reattached to the posterior border of greater troehanter through several bone holes after replacement. In group B, external rotator muscle was not reconstructed. The incidence of postoperative arthrosis posterior dislocation was compared between the two groups. Results All patients were followed up for 8 -40 months. Postoperative arthrosis posterior dislocation occurred in 1 patient in group A and in 6 patients （ 1 patient with cerebral infarction race failed to follow-up in group B. The incidence of postoperative arthrosis posterior dislocation in group was significantly lower than that in group B（ P 〈 0.05 ）. Conclusion External rotator muscle integrity of the reconstruction between greater troehanter can reduce the incidence of postoperative arthrosis posterior dislocation after primary total hip arthroplasty through posterior approach. The technique can strengthen the posterior soft tissue of the joint,it helps to enhance the stabilization of the hip, meanwhile it can reduce the suffering caused by postoperative complications in patients, hospital costs, patient recovery time and reduce the impact on the physical and mental health of a patient.