后方软组织修复预防髋关节置换术后早期脱位

目的 探讨加强修补后方软组织预防行后外侧切口首次人工全髋关节置换术(THA)后早期脱位的临床疗效.方法 回顾性分析66例首次THA术中缝合后方完整的关节囊外旋短肌腱瓣至股骨大转子部分的患者术后早期脱位率.术中观察显示修补关节囊能够限制髋关节过度内旋,阻止股骨头假体在髋臼内衬内的初始滑动.结果 66例手术切口长度7 ～18 cm,平均14.5 cm；手术时间70～125 min,平均90 min；出血量210 ～ 650 ml,平均350 ml.无严重并发症.Harris评分优41例,良20例,中5例,优良率达92.4％ (61/66).66例随访24～60周(平均40周),无一例发生术后早期脱位.结论 在假体安放正确基础上,加强修补后方关节囊能够有效预防行后外侧切口首次THA术后早期脱位,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.

Prevention of early dislocation rate after total hip arthroplasty with posterior capsulotendinous repair

Objective To investigate the clinical results and significance and mechanism of early dislocation rate after total hip arthroplasty（THA） following the posterolateral approach with posterior capsuiotendinous repair. Methods The incidence of early dislocation among 66 consecutive primary THA with the posterior capsule and the short extend rotators sutured to the greater trochanter were reviewed. The repaired soft-tissue limited the excess internal rotation and the head initial slides in the polyethylene insert of aeetabular component which was measured intraoperatively. Results During 24-60 weeks （40 weeks on average） follow-up, the patients with posterior capsulotendinous repair had no early posterior dislocation. Conclusion With the correct orientation of components and an enhanced capsulotendinous repair , the posterolateral approach can result in low early dislocation rate. Retaining articularis during primary THA can minimize operative trauma, reconstruct soft tissue balance and augment hip stability to get postoperative functional recovery.