经后侧入路人工全髋关节置换保留关节囊对关节稳定性的影响

背景:关节囊韧带能够引导关节面的正常运动和限制过度运动的作用,尤为重要的是阻止任何非生理的位移发牛,足稳定髋关节的重要静力结构.既往认为在人工全髋关节置换中应该常规切除关节囊.目的:观察后侧入路人工全髋关节置换过程中保留关节囊结构维持关节稳定性的影响.设计、时间及地点:病例对照实验,2005-01/2006-12在中南大学湘雅二医院骨科住院行人工全髋关节置换治疗61例股骨颈骨折患者的回顾性分析.对象:2006-01/12行人工全髋关节置换保留修复关节囊的29例患者为保留组.2005-01/12行人工全髋关节置换常规切除部分关节囊的32例患者为常规组.两组患者在病例选择,假体选择项目上基线一致,术后处理一致.方法:股骨近端大转子上钻4个孔.用1-0可吸收缝线把上半部分关节囊瓣和原关节囊前上方部分缝合后,再与股骨颁基底部作褥式缝合,缝线暂不打结:另一缝线同样将关节囊瓣下半部分与原关节囊前下方部分缝合后于股骨颈基底下办两个骨孔穿出,外旋下肢.打结缝线,冉修补被切断的外旋肌群.缝合前后可以缓慢屈髋90°和全伸膝位股骨内旋45°,体会关节囊缝合后对加强关节后方稳定的作用.主要观察指标:手术时间、出血量和术后关节脱位情况.结果:①保留组手术时间和出血量低丁常规组(P<0.05).②保留组术后没有脱位发生,常规组术后2例发生脱位,发生率为6.2%.因为数据较少,不能进行统计学检验.因此不具备统计学意义.结论:人工全髋关节置换过程中保留和不保留关节囊对关节稳定性影响还不能作出结论性意见,但保留关节囊手术可以减少手术时间和术中出血,不增加手术风险,并有重建髋关节后侧软组织平衡的作用.

Effect of retaining articular capsule in total hip arthroplasty through posterior approach on hip stability

BACKGROUND:Articular capsule ligaments can lead articular surface to move normally and limit the excessive movement, especially to prevent any non-physiological movement. They are the important structures for stabilizing hip joints. It was previously thought that articular capsule should be routinely resected in the total hip arthroplasty (THA). OBJECTIVE: This study was designed to investigate the effect of retaining articular capsule in THA through posterior approach on maintaining hip stability. DESIGN, TIME AND SETTING: This study, a retrospective case analysis, was performed on 61 patients with femoral neck fracture, who received treatment in the Department of Orthopedics, Xiangya Second Hospital of Central South between January 2005 and December 2006. PARTICIPANTS: Twenty-nine patients who underwent THA with retaining articular capsule from January to December 2006 were included as retaining group, and thirty-two patients who underwent THA with routine resection of partial articular capsule were included as routine group. The two groups were kept identical in case selection, prosthesis selection, post-surgery processing and operators. METHODS: Four holes were drilled on greater trochanter on the proximal femoral bone. The superior part of articular capsule valve was sutured to the superior part of original articular capsule using No.1-0 absorbing thread, then sutured to base of femoral neck in mattress manner, and the suture was not ligated. The inferior part of articular capsule valve was sutured to the inferior part of original articular capsule using another suture. And the suture passed through two bone holes on base of femoral neck. The lower limbs were externally rotated and the suture was ligated. Subsequently, the excised extortor was repaired. Prior to and subsequent to suture, hip was slowly bent for 90° and femur was internally rotated for45°to investigate the suture of articular capsule on strengthening articular stability. MAI OUTCOME MEASURES: Operation time, bleeding volume and hip dislocation after THA. RESULTS: The operation time and bleeding volume were lower in the retaining group than in the routine group (P < 0.05). After THA, hip dislocation did not occur in any patients in the retaining group but occur in 2 patients (6.2%) in the routine group. Statistical tests could not be performed due to less data, resulting in no statistical significance.CONCLUSION: There has been no precise conclusion about the effects of retaining articular capsule or not on hip stability.But retaining articular capsule shortens operation time, reduces intrao-perative bleeding, unable raise operation risk, and re-establishes hip soft tissue balance.