保护股方肌及修复后方软组织对后外侧入路全髋关节置换早期脱位的影响  

Protection of quadratus femoris and posterior soft tissue repair for the prevention of early dislocation in total hip arthroplasty through posterolateral approach

作　　者：史思峰 卢文海 周冰 陈向阳 赵凤朝 郭开今 

机构地区：[1]徐州医科大学附属医院骨科,江苏省徐州市221002

出　　处：《中国组织工程研究》2016年第48期7163-7168,共6页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金(81401817)~~

摘　　要：背景:髋关节脱位是全髋关节置换后主要并发症之一。后外侧入路是髋关节置换的常用手术入路。后方软组织是否进行修复,现在学术界存在争议,而对于股方肌的保护,以往文献未给予充分的关注。目的:探讨在应用后外侧入路进行全髋关节置换时,修复后方软组织、保护股方肌对置换后早期脱位的影响。方法:回顾性分析2013年1月至2015年8月在徐州医科大学附属医院骨科进行的后外侧入路的初次全髋关节置换患者326例的资料。根据术中情况分为观察组和对照组,观察组187例为修复后方软组织、保护股方肌组,对照组139例为不修复后方软组织,部分切开股方肌组。将置换后3个月发生的脱位定义为早期脱位。比较两种方法对置换后早期脱位率的影响。结果与结论:观察组早期脱位1例(1/187,脱位率0.5%),对照组早期脱位5例(5/139,脱位率3.6%)。对照组患者髋关节早期脱位率显著高于观察组(P<0.05)。结果说明,在后外侧入路进行的初次全髋关节置换过程中,采用保护股方肌、修复后方软组织较不修复后方软组织、部分切开股方肌的方式早期脱位率更低。保护股方肌及修复后方软组织对维持髋关节软组织的平衡有一定意义。BACKGROUND： Dislocation after total hip arthroplasty is one of major complications. It is controversial whether posterior soft tissue repair should be carried out during total hip arthroplasty through posterolateral approach and few literatures focus on the protection of quadratus femoris. OBJECTIVE： To explore the effects of quadratus femoris protection and posterior soft tissue repair for the prevention of early dislocation in total hip arthroplasty through posterolateral approach. METHODS： Clinical data of 326 patients from Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical University with primary total hip arthroplasty through posterolateral approach from January 2013 to August 2015 were retrospectively analyzed. According to different strategies of soft tissue management, they were assigned to two groups： observation group（187 patients） and control group（139 patients）. Protection of quadratus femoris and posterior soft tissue repair was carried up in observation group. Control group did not receive posterior soft tissue repair and quadratus femoris was partially damaged. Early dislocation was defined as the dislocation occurred within 3 months after operation. Effects of the two methods on early dislocation were compared after arthroplasty. RESULTS AND CONCLUSION： There was one patient with dislocation in observation group（1/187, 0.5%） in the observation group and five patients with dislocation（5/139, 3.6%） in the control group. Dislocation rate was significantly higher in the control group than in the observation group（P〈0.05）. Results suggested that in primary total hip arthroplasty through posterolateral approach, protection of quadratus femoris and posterior soft tissue repair will reduce early dislocation rate. Protection of quadratus femoris may play a role in keeping the balance of the soft tissue around the hip joint.

关 键 词：关节成形术 置换 髋 脱位 关节囊 髋脱位 组织工程 骨科植入物 人工假体 全髋关节置换 早期脱位 股方肌 外旋肌群 国家自然科学基金 

分 类 号：R318[医药卫生—生物医学工程]