双极股骨头置换中应用带线铆钉修复关节囊治疗高龄患者股骨颈骨折

Capsular-enhanced repair with suture anchors in bipolar hemiarthroplasty for the treatment of femoral neck fractures in elderly patients

目的 :探讨双极股骨头置换中应用带线铆钉强化修复关节囊治疗高龄患者股骨颈骨折的临床疗效。方法:回顾性分析2009年6月至2016年6月收治的53例(54髋)高龄股骨颈骨折患者资料,男21例,女32例;年龄80~97.5岁,平均84.7岁;骨折Garden分型:Ⅱ型11髋,Ⅲ型26髋,Ⅳ型17髋。采用髋关节后路切口,后关节囊倒"T"形切开,安装人工双极股骨头,用带线铆钉加强修复后关节囊和外旋肌群。记录手术时间、术中出血量、住院日、静脉血栓、术后死亡、关节脱位、术后疼痛和假体周围骨折等,末次随访时采用髋关节Harris评分标准评定疗效。结果:在住院期及术后3~36个月(平均11.5个月)随访期间,无关节脱位、术后感染与假体周围骨折。平均手术时间65 min(50~95 min),平均术中出血量213 ml(100~420 ml),平均住院日13.3 d(5~27 d)。深静脉血栓形成2例,肺栓塞1例,小腿肌间静脉丛血栓形成10例,静脉血栓形成的检出率为24.53%(13/53)。术后第1年死亡4例,1例肺栓塞于术后8 d死亡,其余3例分别于术后4、6和7个月死于心脏衰竭。在末次随访期,42例(43髋)无痛,9例有轻度疼痛,2例有中度疼痛。没有卧床患者。髋关节Harris评分91.25±8.39,优44髋、良5髋、可5髋。结论:双极股骨头置换中应用带线铆钉强化修复关节囊治疗高龄患者股骨颈骨折可防止术后人工关节脱位。

Objective：To evaluate the efficacy of capsular-enhanced repair with suture anchors in bipolar hemiarthroplasty for the treatment of femoral neck fractures in elderly patients.Methods：A retrospective study was designed.From June 2009 to June 2016,53 senile patients（54 hips）with femoral neck fracture were treated operatively in Mianyang central hospital（Sichuan,China）.There were 21 males and 32 females,ranging in age from 80 to 97.5 years old（mean,84.7 years old）.There were 11 hips of Garden type Ⅱ,26 hips of Garden type Ⅲ and 17 hips of Garden type Ⅳ.All the patients underwent bipolar hemiarthroplasty with enhanced repair of hip capsular.The hip joint was opened by a T shaped incision over posterior capsule.The posterior hip capsular and short external rotators were repaired particularly after the bipolar prostheses were implanted.Surgical time,intra-operative blood loss,mean hospitalization time,deep venous thrombosis,mortality,hip dislocation,pain,periprosthetic fracture,and other complications were recorded.The functional outcome was evaluated using the Harris Hip Score at the last follow-up.Results：The 53 patients（54 hips） were evaluated during the hospitalization period and a mean follow-up period of 11.5 months（ranged,3 to 36 months）.No dislocation,incision infection and periprosthetic fracture appeared in this group.The mean surgical time was 65 minutes（ranged,50 to 95 min）.The mean intra-operative blood loss was 213 ml（ranged,100 to 420 ml） and the mean hospitalization time was 13.3 days（ranged,5 to 27 days）.Two patients with deep vein thrombosis,one patient with pulmonary embolism and 10 patients with venous plexus thrombosis of calf muscle were diagnosed postoperatively.The rate of venous thrombosis was 24.53%（13/53）.The patient with pulmonary embolism died 8 days after operation and the other 3 patients died from heart failure 4,6 and 7 months after operation respectively.The mortality during first year after hemiarthroplasty was 7.55%（4/53）.At the latest follow-up,42 patients（43 hips）had no pain,9 patients had mild pain,and 2 patients had moderate pain.No patients were non-ambulatory.The mean Harris Hip Score was 91.25±8.39,functional outcome was excellent in 44 hips,good in 5,and fair in 5.Conclusion：The bipolar hemiarthroplasty with capsularenhanced repair with suture anchors is effective in reducing postoperative complications of prosthesis dislocation.