保留关节囊的初次人工全髋关节置换术  

Primary total hip arthroplasty with retained articularis

作　　者：陈勤[1] 邵勇[1] 周政[1] 关龙[1] 胡文竹[1] 余彬[1] 邱建中[1] 梁伟[1] 邓宁[1] 陈坚[1] 

机构地区：[1]成都市第三人民医院骨科,610031

出　　处：《中华创伤杂志》2006年第11期829-832,共4页Chinese Journal of Trauma

摘　　要：目的探讨初次人工全髋关节置换术(total hip arthroplasty,THA)中保留关节囊的重要性及手术方法,以恢复THA术后髋关节软组织平衡。方法2003年2月-2005年8月,采用保留关节囊的THA(R组)41例43髋,男19例,女22例；年龄46～80岁,平均66．5岁。同期采用常规的THA(S组)42例44髋,男20例,女22例；年龄43～80岁,平均64．3岁。患者术前诊断为股骨颈骨折(GardenⅢ、Ⅳ)13例13髋(R组),14例14髋(S组)；髋臼发育不良(CroweⅠ、Ⅱ)9例9髋(R组),8例8髋(S组)；骨性关节炎6例8髋(R组),7例8髋(S组)；股骨头坏死(FicatⅢ、Ⅳ)13例13髋(R组),13例14髋(S组)。其中骨水泥型假体13髋(R组),11髋(S组)；非骨水泥型假体8髋(R组),10髋(S组)；混合型假体双髋22髋(R组),23髋(S组)。两组手术均采用Gibson入路。R组术中应用了保留关节囊和旋后小肌群的方法,可靠地重建术后髋关节软组织平衡。S组采用常规手术入路,切除大部分关节囊,术毕关节囊不作修复。对两组患者的手术切口长度、手术时间、出血量、引流量、输血量,以及术后髋感染、髋脱位、起床站立时间、弃拐行走时间、Harris评分进行比较。结果两组患者均获6～22个月随访,R组平均时间16．5个月,S组平均时间16．7个月。R组各项指标均明显好于S组(P＜0．05)。结论THA术中保留关节囊,可减少手术创伤,重建髋关节软组织平衡,增加术后髋关节的稳定性,更好地恢复髋关节的功能。Objective To explore the importance and methods of retaining articularis during primary total hip arthroplasty （THA） and reconstruct soft tissue balance of hip joint after THA. Methods From February 2003 to August 2005, 41 cases （43 hips） including 19 males and 22 females at age of 46 - 80 years （mean 66.5 years） were treated with THA with retained capsule （Group R） and other 42 cases （44 hips） including 20 males and 22 females at age of 43-80 years （mean 64.3 years） with standard THA （Group S）. Preoperative diagnosis found femoral neck fractures （Garden Ⅲ Ⅳ） in 13 cases （13 hips） in Group R and 14 （14 hips） in Group S; acetabular dysplasia （Crowe Ⅲ） in 9 （9 hips） in Group R and 8 （hips） in Group S; Osteoarthritis in 6 （8 hips） in Group R and 7 （8 hips） in Group S; and femoral head osteonecrosis （Ficat Ⅲ Ⅳ） in 13 （13 hips） in Group R and 13 （14 hips） ih Group S. There were 13 hips of cement prostheses in Group R and 11 in Group S, 8 cementless prostheses in Group R and 8 in Group S, 22 cement and cementless prostheses in Group R and 23 in Group S. Gibson＇ s approach was used in both groups. Group R used the method of retaining capsule and little supination muscles during the operation to reconstruct responsibly soft tissue balancing of postoperation for THA. For comparison, Group S used the method of standard which resected a lots of capsule and didnt reconstruct it. The comparative items between Group R and Group S included incisional length, operative time, operative bleeding, drainage transfusion, infection, dislocation, postoperation standing, postoperation walking and Harris＇ s score. Results All cases in Group R and Group S were followed for 6-22 months （ mean 16.5 months in Group R and 16.7 months in Group S）. There was significantly statistical difference upon interoperative and postoperative data between Group R and Group S. The result of Group R was significantly better than that of GS. Conclusion Retaining articul

关 键 词：关节成形术 置换 髋 关节囊 股骨颈骨折 

分 类 号：R687.4[医药卫生—骨科学]