• 吳江市第一人民醫(yī)院 南通大學(xué)附屬吳江醫(yī)院骨科（江蘇吳江，215200）;

目的探討經(jīng)后外側(cè)入路初次行人工全髖關(guān)節(jié)置換術(shù)（total hip arthroplasty，THA）時(shí)術(shù)中修復(fù)關(guān)節(jié)囊及外旋肌群對(duì)患者預(yù)后的影響。 方法回顧分析2006年1月－2009年6月經(jīng)后外側(cè)入路初次行THA的股骨頸骨折患者159例，根據(jù)后方結(jié)構(gòu)修復(fù)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(nèi)科疾病、假體選擇等一般資料比較，差異均無(wú)統(tǒng)計(jì)學(xué)意義（P  gt; 0.05），具有可比性。A組（n=38）術(shù)中修復(fù)關(guān)節(jié)囊與外旋肌群；B組（n=39）術(shù)中僅修復(fù)關(guān)節(jié)囊，未修復(fù)外旋肌群；C組（n=41）術(shù)中僅修復(fù)外旋肌群，未修復(fù)關(guān)節(jié)囊；D組（n=41）關(guān)節(jié)囊與外旋肌群均未修復(fù)。對(duì)各組出血量、引流量、術(shù)后早期髖關(guān)節(jié)脫位率、Harris評(píng)分以及患髖內(nèi)、外旋范圍等進(jìn)行比較分析。 結(jié)果各組手術(shù)時(shí)間、術(shù)中出血量及引流量比較差異均無(wú)統(tǒng)計(jì)學(xué)意義（P  gt; 0.05）?；颊呔@隨訪，隨訪時(shí)間12～24個(gè)月，平均21.6個(gè)月。A、B、C、D組發(fā)生術(shù)后早期髖關(guān)節(jié)脫位分別有0、0、4（9.8%）、4（9.8%）例，髖關(guān)節(jié)脫位發(fā)生率組間比較差異有統(tǒng)計(jì)學(xué)意義（χ2=7.910，P=0.048）。術(shù)后6周及6、12個(gè)月，各組Harris評(píng)分均較術(shù)前顯著改善（P  lt; 0.05）；組間比較顯示，術(shù)后6周及6個(gè)月D組顯著低于A、B、C組，B、C組低于A組，差異均有統(tǒng)計(jì)學(xué)意義（P  lt; 0.05）；術(shù)后12個(gè)月各組間比較差異均無(wú)統(tǒng)計(jì)學(xué)意義（P  gt; 0.05）。術(shù)后6周及6、12個(gè)月，各組患髖內(nèi)旋范圍比較差異均無(wú)統(tǒng)計(jì)學(xué)意義（P  gt; 0.05）；術(shù)后6周及6個(gè)月，A、C組患髖外旋范圍顯著大于B、D組（P  lt; 0.05）。 結(jié)論THA術(shù)中修復(fù)外旋肌群及關(guān)節(jié)囊不增加術(shù)中出血量及引流量，可降低術(shù)后早期髖關(guān)節(jié)脫位風(fēng)險(xiǎn)，提高患髖關(guān)節(jié)Harris評(píng)分并恢復(fù)其外旋功能。建議經(jīng)后外側(cè)入路行THA術(shù)中常規(guī)修復(fù)關(guān)節(jié)囊及外旋肌群。

引用本文： 沈鵬程,徐能,蔣富貴,朱立帆,翁峰標(biāo),王友華. 經(jīng)后外側(cè)入路初次行人工全髖關(guān)節(jié)置換術(shù)外旋肌群與關(guān)節(jié)囊修復(fù)對(duì)預(yù)后的影響. 中國(guó)修復(fù)重建外科雜志, 2012, 26(11): 1300-1305. doi: 復(fù)制

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(jiǎng), 張力成, 楊國(guó)敬, 等. 后方關(guān)節(jié)囊修補(bǔ)預(yù)防全髖關(guān)節(jié)置換術(shù)后早期脫位. 中國(guó)矯形外科雜志, 2006, 14(12): 891-894.
17. 李永獎(jiǎng), 張力成, 楊國(guó)敬, 等. 人工全髖關(guān)節(jié)置換術(shù)后早期假體脫位的原因及防治措施. 中國(guó)中醫(yī)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(fù)關(guān)節(jié)囊及外旋肌群對(duì)預(yù)防全髖關(guān)節(jié)置換術(shù)后關(guān)節(jié)脫位的作用. 中華創(chuàng)傷骨科雜志, 2008, 10(12): 1138-1140.
  1. 1. Mihalko WM, Whiteside LA. Hip mechanics after posterior structure repair in total hip arthroplasty. Clin Orthop Relat Res, 2004, (420): 194-198.
  2. 2. Sculeo TP,Moran MC. Posterior tenocapsulorthappy in primary total hip arthroplasty.American Academy of Orthop Surgeons. Anaheim: 1991.
  3. 3. Kao JT, Woolson ST. Piriformia tendon repair failure after total hip replacement. Orthop Rev, 1992, 21(2): 171-174.
  4. 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. 5. Robbins GM, Masri BA, Garbuz DS, et al. Treatment of hip instability. Orthop Clin North Am, 2001, 32(4): 593-610, viii.
  6. 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. 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. 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. 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. 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. 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. 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. 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. 14. Osmani O, Malkani A. Posterior capsular repair following total hip arthroplasty: a modified technique. Orthopedics, 2004, 27(6): 553-555.
  15. 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. 16. 李永獎(jiǎng), 張力成, 楊國(guó)敬, 等. 后方關(guān)節(jié)囊修補(bǔ)預(yù)防全髖關(guān)節(jié)置換術(shù)后早期脫位. 中國(guó)矯形外科雜志, 2006, 14(12): 891-894.
  17. 17. 李永獎(jiǎng), 張力成, 楊國(guó)敬, 等. 人工全髖關(guān)節(jié)置換術(shù)后早期假體脫位的原因及防治措施. 中國(guó)中醫(yī)骨傷科雜志, 2007, 15(2): 1-3．.
  18. 18. Liu X, Zhang X, Chen Y, et al. Hidden blood loss after total hip arthroplasty. J Arthroplasty, 2011, 26(7): 1100-1105.
  19. 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. 20. 張磊, 李熙雷, 董健, 等. 修復(fù)關(guān)節(jié)囊及外旋肌群對(duì)預(yù)防全髖關(guān)節(jié)置換術(shù)后關(guān)節(jié)脫位的作用. 中華創(chuàng)傷骨科雜志, 2008, 10(12): 1138-1140.