保留关节囊的全髋置换术治疗不稳定老年股骨颈骨折的病例对照研究

目的:探讨保留关节囊的髋关节置换术和传统的髋关节置换术治疗不稳定老年股骨颈骨折的疗效。方法:选取2010年1月至2015年1月初次接受全髋关节置换术的不稳定老年股骨颈骨折的患者120例,分为保留关节囊的全髋置换术组和传统的全髋置换术组,各60例。保留关节囊组与传统手术组患者的性别分别为(男/女):34/26,31/29;年龄分别为(73.4±4.4)岁和(72.3±4.1)岁。术后随访6个月,观察两组患者的手术时间、术中及术后出血量、住院天数、术后并发症发生率、术后髋关节脱位发生率和髋关节Harris评分。结果:保留关节囊的全髋关节置换术组和传统的全髋关节置换术组手术时间分别为(95.68±6.90)min和(93.39±7.90)min(P0.05);术中及术后出血分别为(998.78±15.20)ml和(1 000.25±16.80)ml(P0.05);住院时间分别为(10.74±2.90)d和(13.25±2.20)d(P0.05);术后1个月内髋关节脱位发生率分别为0%(0/60)和6.67%(4/60)(P0.05)。术后1~6个月的随访中两组患者均未出现髋关节脱位;两组患者术前Harris评分分别是42.18±5.90和43.68±8.20(P0.05),术后1个月时分别为58.53±5.10和49.38±4.90(P0.05),术后6个月分别是91.08±7.50和90.74±7.10(P0.05)。结论:直接外侧入路的保留关节囊的全髋置换术相对于传统不保留关节囊的全髋置换术不增加手术时间和术中出血,对缩短住院时间促进患者恢复,预防术后并发症,早期髋关节脱位,改善患者术后早期髋关节的功能具有重要作用。

Case-control study on retaining articular capsule in the total hip replacement for old patients with unstable femoral neck fractures

Objective: To study the effect of reserving articular capsule and traditional total hip replacement for old patients with unstable femoral neck fractures.Methods: From January 2010 to January 2015,one hundred and twenty patients with femoral neck fracture were retrospective review. Among them,sixty patients were treated with total hip arthroplasty reserving articular capsule,the others were treated with traditional total hip arthroplasty without reserving articular capsule. The gender of reserving articular capsule group and traditional group were (male/female) 34/26,31/29 respectively; the age were (73.4±4.4),(72.3±4.1) years old,respectively. All patients were followed up for six months,the operation time,blood loss,length of stay,incidence of postoperative complications,incidence of postoperative hip dislocation and hip Harris score of the two groups were observed.Results: The operative time of the reserving articular capsule group and traditional group were (95.68±6.90),(93.39±7.90) min (P>0.05),and the blood loss were (998.78±15.20),(1 000.25±16.80) ml (P>0.05). The time for hospital stay were (10.74±2.90),(13.25±2.20) days(P<0.05). The Harris scores were 58.53±5.10,49.38±4.90(P<0.05) at 1 month after operation;91.08±7.50,90.74±7.10(P>0.05) at 6 months after operation.Conclusion: The method of reserving auricular capsule can not increase the operative time and the blood loss. But it has a favorable effect on decreasing the hospital stay,complication,the rate of early dislocation of the hip joint,improving the function of hip joint.