人工全髋关节置换术中后方软组织不同处理方式对术后假体脱位的影响

Early dislocation rate without posterior soft tissue repair after primary total hip arthroplasty

目的观察初次人工全髋关节置换(THA)术中不缝合髋关节囊和股骨外旋短肌断端对术后假体脱位的影响。方法回顾性分析自2006-06—2012-05进行的955例(1 009髋)THA患者,分为2组,THA术中关节囊和外旋短肌止点均缝合处理者为修复组,关节囊和外旋短肌止点均不缝合者或因后方软组织病态、缺损等原因不能修复者为未修复组,修复组474例(498髋),未修复组481例(511髋)。比较2组手术时间、术腔引流量、术后6个月内脱位数、术前及术后髋关节功能Harris评分。结果修复组手术时间(41.6±8.5)min,未修复组为(37.4±7.1)min,未修复组手术时间短于修复组,差异有统计学意义(t=2.03,P<0.05)。修复组(n=198)术腔引流量为(139.4±11.9)ml,未修复组(n=232)为(140.7±10.7)ml,2组差异无统计学意义(t=1.19,P>0.05)。修复组术后髋关节功能Harris评分为(85.9±5.5)分,未修复组为(85.1±5.0)分,2组差异无统计学意义(t=2.42,P>0.05)。2组术后6个月内脱位数差异无统计学意义(χ2=0.29,P>0.05)。结论 THA术后假体脱位主要与假体的位置、术肢的位置和主要肌群的肌力和张力相关,与关节囊和外旋短肌的处理方式无明显相关性。省略后方软组织修复的步骤可缩短手术时间。

Objective To observe the dislocation rate without the hip joint capsule and short external rotators repair in primary total hip arthroplasty（THA）.Methods A total of 955 patients（1 009 hips） undergoing primary THA from June 2006 to May 2012 were retrospectively analyzed,who were divided into two groups,the repaired group in which the hip joint capsule and short external rotators were repaired,including 474 cases（498 hips） and the non-repaired group in which the joint capsule and short external rotators were not repaired for any reasons,including 481 cases（511 hips）.The operation time,the volume of drainage,dislocation cases within 6 months postoperatively and pre-and post-operative Harris hip score were compared between the two groups.Results Operation time was（41.6±8.5）min in the repaired group and（37.4±7.1）min in the non-repaired group,the operation time of non-repaired group was shorter and the difference between the two groups was significant（t =2.03,P〈 0.05）.Volume of drainage after surgery was（139.4±11.9）ml in the repaired group and（140.7±10.7）ml in the non-repaired group,there was no significant difference between the 2 groups（t =1.19,P〉 0.05）.Harris hip score was（85.9±5.5） in the repaired group and（85.1±5.0） in non-repaired group after surgery,the difference was not significant.Dislocation cases within 6 months between the two groups were not significantly different（χ^2=0.29,P 〉0.05）.Conclusion The hip dislocation following THA is closely related to the prosthesis orientation,position of limb and main muscle tensile force around the hip joint,while not relevant to the management of joint capsule and short external rotators.By omitting the process of joint capsule and short external rotators repair,the operation time can be shortened.