偏瘫侧股骨颈骨折关节置换中软组织不同重建方式的临床疗效

The clinical effect of different reconstruction methods of soft tissue for hip arthroplasty with hemiplegic femoral neck fractures

目的观察对比高龄偏瘫侧GardenⅢ、Ⅳ股骨颈骨折髋周软组织不同重建方式的临床疗效。方法选取2015年6月至2018年5月在我院就诊的高龄偏瘫侧GardenⅢ、Ⅳ股骨颈骨折患者76例,其中A组40例行双极人工股骨头置换,交叉捆扎方法重建外旋肌群的腱性部分,B组36例同期常规行双极人工股骨头置换,比较两组手术时间、术中出血量、术后早期髋关节功能Harris评分、股骨头脱位率以及术后早期并发症的发生情况。结果(1)A、B两组患者手术时间、术中出血量差异均无统计学意义(P>0.05);(2)两组患者术后下床时间无明显差别(P>0.05);(3)两组患者股骨头脱位5例,A组0例,B组5例(P<0.05);(4)两组术后早期并发症的发生率差异无统计学意义(P>0.05);(5)术后1周、1个月随访时A组髋关节功能优于B组(P<0.05),6个月、1年随访时两组Harris评分均显著提高,差异无统计学意义(P>0.05)。结论双极人工股骨头置换治疗偏瘫侧GardenⅢ、Ⅳ股骨颈骨折术中采用交叉捆扎方法重建外旋肌群腱性部分的技术,可有效减少后侧入路引起的股骨头脱位,改善术后早期髋关节功能。

Objective Comparative observation on the clinical efficacy of different reconstruction methods of soft tissue in the treatment for GardenⅢandⅣhemiplegic femoral neck fractures among elderly patients.Methods 76 elderly patients with hemiplegic side femoral neck fractures were divided into two groups.In group A,40 cases were treated with bipolar artificial femoral head replacement,and the tendinous part of external circumflex muscle group was cross-bundled into bundles for reconstruction and fixation.36 cases in group B were treated with routine suture of joint capsule and external circumflex muscle during bipolar artificial femoral head replacement.The operation time,intraoperative bleeding volume,Harris score of early postoperative hip joint function,dislocation rate of femoral head and the occurrence of early postoperative complications were compared between the two group.Results(1)There was no significant difference in operation time and intraoperative blood loss between the two groups(P>0.05).(2)There was no significant difference in postoperative out of bed time between the two groups(P>0.05).(3)Five patients in group B suffered from early prosthetic dislocation,but none in group A(P<0.05).(4)There was no significant difference in early postoperative complications between the two groups(P>0.05).(5)The hip joint function of patients in group A was better than that in group B at 1 week and1 month follow-up after operation,and the Harris score of the two groups significantly increased at half a year and one year follow-up after operation while there was no significant difference between the two groups(P>0.05).Conclusions Bipolar artificial femoral head replacement was used to treat GardenⅢon the paraplegic side.The technique of reconstructing the tendon part of rotatory muscles by means of cross-binding method can reduce the dislocation of the femoral head by the posterior approach,and improve the function of the hip joint at the early stage after operation.