关节囊及外旋肌群修补在后外侧入路初次全髋关节置换术的应用

Posterior capsular and the external rotation muscles repair in primary total hip arthroplasty with posterior approach

目的探讨关节囊及外旋肌群修补在后外侧入路初次全髋关节置换术(total hip arthroplasty,THA)中的临床意义和手术方法。方法回顾分析2008年1月~2011年8月后外侧入路初次THA术患者186例,根据术中是否修补关节囊及外旋肌群将患者分为两组:A组90例,'T'形切开关节囊,术毕将关节囊及外旋肌群原位缝合于大转子后方;B组96例,切除后关节囊,术毕未行外旋肌群修补。对两组患者的手术时间、出血量、引流量、术后首次下地时间、感染、早期脱位率、Harris评分进行比较。结果随访12~42个月(平均27.5±7.8个月),其中A组随访(27.2±7.9)个月,B组随访(27.9±7.8)个月。手术时间、感染率、术后Harris评分无明显差异,余各项指标A组均优于B组。结论后外侧入路THA术中关节囊及外旋肌群修补,创伤小,出血少,有利于增加髋关节的稳定性,有效的降低早期脱位率。

Objective To evaluate, retrospectively, the the effect of posterior capsular and the short external rotator muscles repairing in primary total hip arthroplasty through posterolateral approach. Methods A total of 186 patients undergoing186 primary THA surgical procedures in the period from January 2008 to August 2011 inclusively were included in this study. The patients were separated into two groups by whether the posterior capsular and short external rotator muscles repair had been incorporated in the surgical procedure. Group A included 90 hips from 90 patients, for whom were performed the posterior capsular with'T'-shaped incision, and were meticulous repaired of the capsule and the external rotation muscles undertaken at the completion of surgery. Group B comprised 96 hips from 96 patients for whom the posterior capsule was excised and not repaired of the external rotation muscles during THA surgery. The comparative items between Group A and Group B included operative time, operative bleeding, drainage transfusion, infection, dislocation,postoperation standing and Harris' s score. Results All cases in Group A and Group B were followed for 12 to 42 months,mean( 27.5±7.8) months). Operative time, infection, Harris' s score was no significant difference in the two group. The other facts of Group A was significantly better than that of Group B. Conclusion Retaining the capsule and the short external rotator muscles during primary THA can reduce the trauma, lessen bleeding, help to increase hip stability and Effectively reduce the rate of early dislocation.