后外侧结构重建在新鲜股骨颈骨折人工股骨头置换术中的应用

目的探讨后外侧结构重建对后外侧入路人工股骨头置换术术后早期关节脱位的影响。方法选取2016年9月至2017年8月于我院行后外侧入路初次人工股骨头置换术的股骨颈骨折患者60例,根据术中是否修补关节囊及外旋肌群分为重建组(33例:舌形切开关节囊,术中将关节囊及外旋肌群原位缝合在大转子后方及臀中肌肌腱附着处)和对照组(27例:切除关节囊后,术中未进行外旋肌群修复重建)。比较两组的手术情况及术后近期关节功能情况。结果重建组的手术时间为(45.0±15.3) min,长于对照组的(35.0±12.4) min (P <0.05)。重建组术腔引流量为(200.0±80.0) m L,少于对照组的(420.0±120.6) m L (P <0.05)。重建组的早期脱位率为0.000%(0例),与对照组的7.407%(2例)比较无统计学差异(P>0.05)。重建组术后Harris评分为(92.0±3.4)分,高于对照组的(88.2±5.0)分(P <0.05)。结论在后外侧入路人工股骨头置换过程中行后外侧结构重建能够有效减少术腔引流量,提高髋关节Harris评分,对维持髋关节软组织平衡具有重要意义。

Application of Posterolateral Structural Reconstruction in Artificial Femoral Head Arthroplasty through Posterolateral Approach for Fresh Femoral Neck Fracture

Objective To explore the influence of posterolateral structural reconstruction on early joint dislocation after artificial femoral head arthroplasty through posterolateral approach. Methods 60 patients with femoral neck fracture undergoing primary artificial femoral head arthroplasty through posterolateral approach in our hospital from September 2016 to August 2017 was selected and divided into reconstruction group(33 cases: the tongue-shaped incision was used to suture the joint capsule and the external rotation muscle group in the posterior trochanter and the gluteal muscle tendon attachment) and control group(27 cases : the external rotation muscle group was not repaired and reconstructed after joint capsule resection) according to whether the joint capsule and external rotation muscle group were repaired during the operation or not. The operation conditions and recent joint function after operation of the two groups were compared.Results The operation time of the reconstruction group was(45.0 ± 15.3) min, longer than(35.0 ± 12.4) min of the control group(P <0.05).The drainage volume of operative cavity in the reconstruction group was(200.0 ± 80.0) m L, less than(420.0 ± 120.6) mL in the control group(P <0.05). The early dislocation rate of the reconstruction group was 0.000%(0 case), which had no statistical difference with 7.407%(2 cases) of the control group(P >0.05). The Harris score of the reconstruction group was(92.0 ± 3.4) points, higher than(88.2 ± 5.0) points of the control group(P <0.05). Conclusions Posterolateral structural reconstruction during artificial femoral head arthroplasty through posterolateral approach can effectively reduce the drainage volume of operative cavity, and improve the Harris score of hip joint, which is of great significance to maintain the soft tissue balance of hip joint.