全髋关节置换术后关节囊及外旋肌修复的B超观察  

Different methods of posterior capsule and external rotators reparation in total hip arthroplasty

作　　者：周一新[1] 郭盛杰[1] 陈涛[2] 刘庆[1] 唐竞[1] 

机构地区：[1]北京积水潭医院矫形骨科,100035 [2]北京积水潭医院超声科,100035

出　　处：《中华骨科杂志》2009年第6期530-533,共4页Chinese Journal of Orthopaedics

基　　金：北京市优秀人才培养资助项目（20061D0300200066）

摘　　要：目的 分析全髋关节置换术后关节囊及外旋肌不同修复方法的确切性。方法 43例单侧股骨头坏死行人工全髋关节置换术患者，男37例，女6例；年龄31-52岁，平均45．6岁。常规采用后外侧人路、生物固定型假体。其中21髋将后关节囊及外旋肌修复于股骨大转子后缘（骨性修复方法），22髋修复于臀中肌后缘接近股骨大转子连接部（软组织修复方法）。其他手术技术完全相同。于术前、术后6周及术后3个月进行Harris评分；术后6周及3个月以B超检测后关节囊及外旋肌修复的完整性。B超检查采用双盲法，图像中修复部位不连续超过50％视为连续性差或修复失效，不连续少于50％定义为连续性好或修复成功。结果 两组患者术前、术后6周及术后3个月的Harris评分差异无统计学意义。术后6周B超检查显示骨性修复方法组修复成功率57．1％（12／21）；软组织修复方法组86．4％（19／22），差异有统计学意义（χ^2=4．560，P=0．033）。术后3个月修复成功率与术后6周无变化。结论 全髋关节置换术中将后关节囊及外旋肌修复于股骨大转子后缘相对修复于臀中肌后缘失败率更高，建议将后关节囊与外旋肌缝合于臀中肌后缘接近股骨大转子连接部。Objective To explore the validity of different methods used to repair posterior capsule and external rotators in primary total hip arthroplasty. Methods Forty-three patients （37 males, 6 females） undergoing unilateral total hip arthroplasty for unilateral femoral head avascular necrosis were selected, aging from 31 to 52 years old （average 45.6 years old）. The surgery was performed via conventional posterolateral approach. The patients were randomized into two groups： 21 cases had their posterior capsule and external rotators reattached to the posterior edge of femoral greater trochanter （bony reattachments）, whereas the other 22 cases had their posterior structures reattached to inferior posterior edge of the gluteus medius muscle （soft tissue reattachment）. The patients in both groups were evaluated with Harris scores before operation, 6 weeks and 3 months after operation. The integrity of reattachment was double blinded detected by type B ultrasonography at the 6th week and the 3rd month after operation. Discontinuance for more than 50% of repaired tissue was defined as poor continuity and repair failure. Results Harris scores before operation, 6 weeks and 3 months after operation in both groups showed no significant difference. Ultrasonic inspection at 6 weeks and 3 months after operation both showed that the rate of good repair was 57.1% （12/21） for the group of bony reattachment and 86.4% （19/22） for the group of soft tissue reattachment （χ^2=4.560,P=0.033）. Con- clusion Failure rate of reattachment of posterior capsule and external rotators to posterior edge of the greater trochanter is higher than that of posterior structures reattaehment to the inferior posterior edge of the gluteus medius muscle. Soft tissue reattachment of posterior structures during THA is recommended.

关 键 词：关节成形术 置换 膝 股骨头坏死 超声检查 

分 类 号：R686[医药卫生—骨科学]