摘要
[目的]探讨人工关节置换治疗粗隆间粉碎性骨折中后关节囊软组织复合结构整体修复与重建术对髋关节稳定的作用。[方法]回顾性分析2006年1月～2011年3月采用人工髋关节置换治疗不稳定型股骨粗隆间骨折43例患者临床资料,28例后关节囊软组织结构的整体修复采用骨膜-腱-关节囊复合组织瓣的分离与重建技术。男17例,女11例;平均(71.6±6.3)岁。粗隆间骨折按Evans-Jensen分型,Ⅱ型22例,Ⅲ型6例。同期对照15例采用外旋短肌腱-关节囊结构缝合的人工髋关节置换术,男8例,女7例;平均年龄(73.5±5.1)岁。通过对比分析两种后关节囊软组织结构修复与重建技术的手术效果和髋关节功能。[结果]后关节囊软组织结构的整体修复组和外旋短肌腱-关节囊结构常规修复组在手术时间、术中出血量及术后引流量及切口长度的比较差异无统计学意义(P>0.05)。两组后关节囊平均临界撕裂角度分别为(45.2±6.8)°和(41.5±5.2)°,两组比较差异有统计学意义(P<0.05)。两组Harris评分平均分别为(93.3±3.1)分和(90.2±3.3)分,差异无统计学意义(P>0.05)。[结论]粗隆间骨折可造成关节囊软组织结构的破损,人工关节置换时需仔细修复与重建。骨膜-腱-关节囊复合结构分离与整体重建可有效恢复后关节囊结构的完整和关节的稳定性。
[ Objective ] To explore the method and clinical outcome of total posterior soft tissue reconstruction for primary hip arthroplasty in treatment of unstable femoral intertrochanteric fracture. [ Method ] A retrospective control study was made on the clinical data and images of 43 patients with unstable femoral intertroehanteric fracture who were treated with primary hip ar- throplasty from January 2006 to March 2010. They were divided into two groups by two different techniques of repairing of poste- rior soft structures. Twenty-eight patients, 17 males and 11 females with an average age of 71.6 ± 6.3 years were treated with re- attaching a periosteum - tendon - capsular compound soft tissue technique in hip arthroplasty. The traditional posterior capsule repair was used in 15 patients in control group. [ Result]The patients were followed up for an average of 24.5 months （from 10 to 49 months） in total capsular compound soft tissue technique group and 25 months（36 to 72 months） in traditional posterior capsular repair group. There were no significant differences（ P 〉 0.05 ） between the two group regarding to length of incision, in- troperative blood loss and postoperative drainage. The average impending avulsion angle was 45.2° ＋ 6.8° in total capsular com- pound soft tissue technique group and 41.5 °± 5.2°in traditional posterior capsular repair group（ P 〈 0.05 ）. At the last follow - up, no significant difference was found in Harris scores between the two groups （93.3 ＋ 3.1 versus 90.2 ＋3.3, P 〉 0.05 ）. [ Conclusion] Intertrochanteric fracture always destroys the capsular structure of hip, and reconstruction of posterior capsular is necessary in treatment of intertrochanteric fracture by hip arthroplasty. It can acquired excellent results for unstable intertrochan- teric fracture. The total capsular compound soft tissue reconstruction technique can get excellent repair of the posterior capsular and provide good stability of hip arthroplasty.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2012年第18期1665-1669,共5页
Orthopedic Journal of China
关键词
粗隆间骨折
关节置换
髋
关节囊
重建
intertrochanteric fractures, arthroplasty, hip, capsular, reconstruction
