經后外側入路初次行人工全髖關節置換術外旋肌群與關節囊修復對預后的影響_《中國修復重建外科雜志》

作者：

沈鵬程 , 徐能 , 蔣富貴 , 朱立帆 , 翁峰標 , 王友華

吳江市第一人民醫院南通大學附屬吳江醫院骨科（江蘇吳江，215200）;

關鍵詞：

人工全髖關節置換術外旋肌群縫合關節囊修復髖關節脫位

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目的探討經后外側入路初次行人工全髖關節置換術（total hip arthroplasty，THA）時術中修復關節囊及外旋肌群對患者預后的影響。方法回顧分析2006年1月－2009年6月經后外側入路初次行THA的股骨頸骨折患者159例，根據后方結構修復方式不同分為A、B、C、D 4組。4組患者性別、年齡、致傷原因、病程、骨折類型、合并內科疾病、假體選擇等一般資料比較，差異均無統計學意義（P gt; 0.05），具有可比性。A組（n=38）術中修復關節囊與外旋肌群；B組（n=39）術中僅修復關節囊，未修復外旋肌群；C組（n=41）術中僅修復外旋肌群，未修復關節囊；D組（n=41）關節囊與外旋肌群均未修復。對各組出血量、引流量、術后早期髖關節脫位率、Harris評分以及患髖內、外旋范圍等進行比較分析。結果各組手術時間、術中出血量及引流量比較差異均無統計學意義（P gt; 0.05）。患者均獲隨訪，隨訪時間12～24個月，平均21.6個月。A、B、C、D組發生術后早期髖關節脫位分別有0、0、4（9.8%）、4（9.8%）例，髖關節脫位發生率組間比較差異有統計學意義（χ2=7.910，P=0.048）。術后6周及6、12個月，各組Harris評分均較術前顯著改善（P lt; 0.05）；組間比較顯示，術后6周及6個月D組顯著低于A、B、C組，B、C組低于A組，差異均有統計學意義（P lt; 0.05）；術后12個月各組間比較差異均無統計學意義（P gt; 0.05）。術后6周及6、12個月，各組患髖內旋范圍比較差異均無統計學意義（P gt; 0.05）；術后6周及6個月，A、C組患髖外旋范圍顯著大于B、D組（P lt; 0.05）。結論THA術中修復外旋肌群及關節囊不增加術中出血量及引流量，可降低術后早期髖關節脫位風險，提高患髖關節Harris評分并恢復其外旋功能。建議經后外側入路行THA術中常規修復關節囊及外旋肌群。

引用本文： 沈鵬程,徐能,蔣富貴,朱立帆,翁峰標,王友華. 經后外側入路初次行人工全髖關節置換術外旋肌群與關節囊修復對預后的影響. 中國修復重建外科雜志, 2012, 26(11): 1300-1305. doi: 復制

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2.	Sculeo TP,Moran MC. Posterior tenocapsulorthappy in primary total hip arthroplasty.American Academy of Orthop Surgeons. Anaheim: 1991.
3.	Kao JT, Woolson ST. Piriformia tendon repair failure after total hip replacement. Orthop Rev, 1992, 21(2): 171-174.
4.	Stähelin T, Vienne P, Hersche O. Failure of reinserted short external rotator muscles after total hip arthroplasty. J Arthroplasty, 2002, 17(5): 604-607.
5.	Robbins GM, Masri BA, Garbuz DS, et al. Treatment of hip instability. Orthop Clin North Am, 2001, 32(4): 593-610, viii.
6.	Yamaguchi T, Nation M, Asayama I, et al. The effect of posterolateral reconstruction on range of motion and strength in total hip arthroplasty. J Arthroplasty, 2003, 18(3): 347-351.
7.	Ko CK, Law SW, Chiu KH. Enhanced soft tissue repair using locking loop stitch after posterior approach for hiphemiarthroplasty. J Arthroplasty, 2001, 16(2): 207-211.
8.	Suh KT, Park BG, Choi YJ. A posterior approach to primary total hip arthroplasty with soft tissue repair. Clin Orthop Relat Res, 2004, (418): 162-167.
9.	Ji HM, Kim KC, Lee YK, et al. Dislocation after total hip arthroplasty: a randomized clinical trial of a posterior approach and a modified lateral approach. J Arthroplasty, 2012, 27(3): 378-385.
10.	Chiu FY, Chen CM, Chung TY, et al. The effect of posterior capsulorrhaphy in primary total hip arthroplasty. J ArthropIasty, 2000, 15(2): 194-199.
11.	Khan JT, Yao F, Li M, et al. Capsular-enhanced repair of the short external rotators after total hip arthroplasty. J ArthropIasty, 2007, 22(6): 840-843.
12.	Chivas DJ, Smith K, Tanzer M. Role of capsular repair on dislocation in revision total hip arthroplasty. Clin Orthop Relat Res, 2006, (453): 147-152.
13.	Stahelin T, Drittenbass L, Hersece O, et al. Failure of capsular enhanced short external rotator repair after total hip replacement. Clin Orthop Relat Res, 2004, (420): 199-204.
14.	Osmani O, Malkani A. Posterior capsular repair following total hip arthroplasty: a modified technique. Orthopedics, 2004, 27(6): 553-555.
15.	White RE Jr, Forness TJ, Allman JK, et al. Effect of posterior capsular repair on early dislocation in primary total hip replacement. Clin Orthop Relat Res, 2001, (393): 163-167.
16.	李永獎, 張力成, 楊國敬, 等. 后方關節囊修補預防全髖關節置換術后早期脫位. 中國矯形外科雜志, 2006, 14(12): 891-894.
17.	李永獎, 張力成, 楊國敬, 等. 人工全髖關節置換術后早期假體脫位的原因及防治措施. 中國中醫骨傷科雜志, 2007, 15(2): 1-3．.
18.	Liu X, Zhang X, Chen Y, et al. Hidden blood loss after total hip arthroplasty. J Arthroplasty, 2011, 26(7): 1100-1105.
19.	Tarasevicius S, Kesteris U, Kalesinskas RJ, et al. Dynamics of hip joint effusion after posterior soft tissue repair in total hip arthroplasty. Int Orthop, 2006, 30(4): 233-236.
20.	張磊, 李熙雷, 董健, 等. 修復關節囊及外旋肌群對預防全髖關節置換術后關節脫位的作用. 中華創傷骨科雜志, 2008, 10(12): 1138-1140.

1. Mihalko WM, Whiteside LA. Hip mechanics after posterior structure repair in total hip arthroplasty. Clin Orthop Relat Res, 2004, (420): 194-198.
2. Sculeo TP,Moran MC. Posterior tenocapsulorthappy in primary total hip arthroplasty.American Academy of Orthop Surgeons. Anaheim: 1991.
3. Kao JT, Woolson ST. Piriformia tendon repair failure after total hip replacement. Orthop Rev, 1992, 21(2): 171-174.
4. Stähelin T, Vienne P, Hersche O. Failure of reinserted short external rotator muscles after total hip arthroplasty. J Arthroplasty, 2002, 17(5): 604-607.
5. Robbins GM, Masri BA, Garbuz DS, et al. Treatment of hip instability. Orthop Clin North Am, 2001, 32(4): 593-610, viii.
6. Yamaguchi T, Nation M, Asayama I, et al. The effect of posterolateral reconstruction on range of motion and strength in total hip arthroplasty. J Arthroplasty, 2003, 18(3): 347-351.
7. Ko CK, Law SW, Chiu KH. Enhanced soft tissue repair using locking loop stitch after posterior approach for hiphemiarthroplasty. J Arthroplasty, 2001, 16(2): 207-211.
8. Suh KT, Park BG, Choi YJ. A posterior approach to primary total hip arthroplasty with soft tissue repair. Clin Orthop Relat Res, 2004, (418): 162-167.
9. Ji HM, Kim KC, Lee YK, et al. Dislocation after total hip arthroplasty: a randomized clinical trial of a posterior approach and a modified lateral approach. J Arthroplasty, 2012, 27(3): 378-385.
10. Chiu FY, Chen CM, Chung TY, et al. The effect of posterior capsulorrhaphy in primary total hip arthroplasty. J ArthropIasty, 2000, 15(2): 194-199.
11. Khan JT, Yao F, Li M, et al. Capsular-enhanced repair of the short external rotators after total hip arthroplasty. J ArthropIasty, 2007, 22(6): 840-843.
12. Chivas DJ, Smith K, Tanzer M. Role of capsular repair on dislocation in revision total hip arthroplasty. Clin Orthop Relat Res, 2006, (453): 147-152.
13. Stahelin T, Drittenbass L, Hersece O, et al. Failure of capsular enhanced short external rotator repair after total hip replacement. Clin Orthop Relat Res, 2004, (420): 199-204.
14. Osmani O, Malkani A. Posterior capsular repair following total hip arthroplasty: a modified technique. Orthopedics, 2004, 27(6): 553-555.
15. White RE Jr, Forness TJ, Allman JK, et al. Effect of posterior capsular repair on early dislocation in primary total hip replacement. Clin Orthop Relat Res, 2001, (393): 163-167.
16. 李永獎, 張力成, 楊國敬, 等. 后方關節囊修補預防全髖關節置換術后早期脫位. 中國矯形外科雜志, 2006, 14(12): 891-894.
17. 李永獎, 張力成, 楊國敬, 等. 人工全髖關節置換術后早期假體脫位的原因及防治措施. 中國中醫骨傷科雜志, 2007, 15(2): 1-3．.
18. Liu X, Zhang X, Chen Y, et al. Hidden blood loss after total hip arthroplasty. J Arthroplasty, 2011, 26(7): 1100-1105.
19. Tarasevicius S, Kesteris U, Kalesinskas RJ, et al. Dynamics of hip joint effusion after posterior soft tissue repair in total hip arthroplasty. Int Orthop, 2006, 30(4): 233-236.
20. 張磊, 李熙雷, 董健, 等. 修復關節囊及外旋肌群對預防全髖關節置換術后關節脫位的作用. 中華創傷骨科雜志, 2008, 10(12): 1138-1140.

《中國修復重建外科雜志》

經后外側入路初次行人工全髖關節置換術外旋肌群與關節囊修復對預后的影響

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《中國修復重建外科雜志》

經后外側入路初次行人工全髖關節置換術外旋肌群與關節囊修復對預后的影響

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