甄平;李旭升;田琦;周胜虎;李生贵;

• 1:兰州军区兰州总医院全军骨科中心关节外科

摘要(Abstract)：

[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。

关键词(KeyWords)： 粗隆间骨折;关节置换;髋;关节囊;重建

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 甄平;李旭升;田琦;周胜虎;李生贵;

Email:

DOI:

参考文献(References)：

• [1]Chen KC,Gill GS.Cemented hemiarthroplasties for elderly patients withintertrochanteric fractures[J].Clin Orthop,2000,371:206-215.
• [2]吴海山.科学审慎对待人工关节置换术治疗股骨粗隆间骨折[J].中国骨与关节损伤杂志,2009,9:769.
• [3]Rodop O,Kira A,Kaplan H,et al.Primary bipolar hemi prosthesis forunstable intertrochanteric fractures[J].Int Orthop,2002,4:233-237.
• [4]叶冬平,李锋生,梁伟国,等.半髋关节置换与PFN内固定治疗高龄不稳定型股骨粗隆间骨折的疗效比较[J].中国矫形外科杂志,2009,18:1371-1374.
• [5]Khan RJ,Yao F,Li M,et al.Capsular-enhanced repair of the short ex-ternal rotators after total hip arthroplasty[J].J Arthroplasty,2007,22:840-843.
• [6]Bush JB,Wilson MR.Dislocation after hip hemiarthroplasty:anteriorversus posterior capsular approach[J].Orthopedics,2007,30:138-144.
• [7]Harris WH.Traumatic arthritis of the hip after dislocation and acetabu-lar fracture-treatment by mold arthroplasty:an end-result study using anew method of result evaluation[J].J Bone Jonit Surg Am,1969,4:737-755.
• [8]Nakamura Y,Mirsui H,Kikuchi A,et al.Total hip arthroplasty using acylindrical cementless stem in patients with a small physique[J].J Ar-throplasty,2011,1:77-81.
• [9]Halbert J,Crotty M.Multi-disciplinary rehabilitation after hip fracture isassociated with improved outcome:a systematic review[J].J RehabilMed,2007,39:507-512.
• [10]杨睿,李卫平,黄霖,等.小切口不保留关节囊的全髋关节置换术[J].中华关节外科杂志(电子版)2010,1:54-62.
• [11]Chivas DJ,Smith K,Tranzer M.Role of capsular repair on dislocation in revision total hip arthroplasty[J].Clin Orthop,2006,453:147-152.
• [12]Sch KT,Park BG,Choi YJ,et al.A posterior approach to primary to-tal hip arthroplasty with soft tissue repair[J].Clin Orthop,2004,418:162-167.
• [13]Stahelin T,Vienne P,Hersche O.Failure of capsular enhanced short external rotator repair after total hip replacement[J].Clin Orthop,2004,420:199-204.
• [14]Sculco TP,Moran MC.Posterior tenocapsulorrhappy in primary total hip arthroplasty[R].Chicago:Meeting of the American Academy of Orthopaedic Surgeons,1991.
• [15]Pellicci PM,Bostrom M,Ross R.Posterior approach to total hip re-placement using enhanced posterior soft tissue repair[J].Clin Or-thop,1998,355:224-228.
• [16]Iorio R,Specht LM,Healy WL,et al.The effect of EPSTR and mini-mal incision surgery on dislocation after THA[J].Clin Orthop,2006,447:39-42.
• [17]易诚青,曹云,王秋根,等.经骨膜下分离骨膜-腱-囊复合组织瓣的全髋关节置换后路重建技术[J].中华创伤骨科杂志,2011,7:607-612.
• [18]Park Y,Shin H,Chio D,et al.Primary stability of cementless stem in THA improved with reduces interfacial gaps[J].J Biomech Eng,2008,1:1-7.