CAJ | 학술논문

目的探讨骨膜-腱-囊复合组织瓣的骨膜下分离与重建技术对修复髋关节后方稳定结构的作用.方法回顾性分析2002年7月至2010年1月采用骨膜-腱-囊复合组织瓣的骨膜下分离与重建技术行初次伞髋关节置换术的177例患者资料,作为研究组,男75例,女102例;平均年龄为(68.5±8.2)岁.以同期采用大转子钻孔重建技术行全髋关节置换术的150例患者作为对照组,男65例,女85例;平均年龄为(73.0±4.9)岁.通过分析2种重建技术的即时效果、后期效果及功能预后,评估新术式的临床价值.结果研究组与对照组患者的平均临界撕裂角度分别为42.0°±8.2°、35.0°±5.7°;术后3个月关节囊充盈率分别为72.3%(128/177)、53.3%(80/150),大转子区骨密度平均分别为(1.535 ±0.020)、(0.811±0.148)g/cm2,以上指标两组间比较差异均有统计学意义(P<0.05).327例患者术后获12～36个月(平均25.5个月)随访.末次随访时研究组与对照组Harris评分平均分别为(89.7±5.9)、(91.4±11.5)分,差异无统计学意义(P>0.05).研究组与对照组Oxford髋关节评分平均分别为(53.2±0.8)、(45.4±1.6)分,差异有统计学意义(P<0.05).结论骨膜-腱-囊组织瓣分离与重建技术结合了弹性终点与骨性愈合的重建方式,在重建完整性、稳定性及愈合方式方面效果更理想,且可获得更满意的功能预后.
목적 탐토골막-건-낭복합조직판적골막하분리여중건기술대수복관관절후방은정결구적작용.방법회고성분석2002년7월지2010년1월채용골막-건-낭복합조직판적골막하분리여중건기술행초차산관관절치환술적177례환자자료,작위연구조,남75례,녀102례;평균년령위(68.5±8.2)세.이동기채용대전자찬공중건기술행전관관절치환술적150례환자작위대조조,남65례,녀85례;평균년령위(73.0±4.9)세.통과분석2충중건기술적즉시효과、후기효과급공능예후,평고신술식적림상개치.결과연구조여대조조환자적평균림계시렬각도분별위42.0°±8.2°、35.0°±5.7°;술후3개월관절낭충영솔분별위72.3%(128/177)、53.3%(80/150),대전자구골밀도평균분별위(1.535 ±0.020)、(0.811±0.148)g/cm2,이상지표량조간비교차이균유통계학의의(P<0.05).327례환자술후획12～36개월(평균25.5개월)수방.말차수방시연구조여대조조Harris평분평균분별위(89.7±5.9)、(91.4±11.5)분,차이무통계학의의(P>0.05).연구조여대조조Oxford관관절평분평균분별위(53.2±0.8)、(45.4±1.6)분,차이유통계학의의(P<0.05).결론골막-건-낭조직판분리여중건기술결합료탄성종점여골성유합적중건방식,재중건완정성、은정성급유합방식방면효과경이상,차가획득경만의적공능예후.
Objective To explore the effect of a modified posterior repair via per-subperiosteal stripping and reattaching a periosteum-tendon-capsular compound tissue flap on the posterior stability of the hip joint in total hip arthroplasty (THA) . Methods From July 2002 through January 2010, 177 patients (study group), 75 males and 102 females with an average age of 68. 5 ± 8. 2 years, were treated with the modified posterior repair to reconstruct the posterior structures. They were compared with other contemporary 150 patients (control group), 65 males and 85 females with an average age of 73. 0 ±4. 9 years, who were treated with traditional THA by drilling in the greater trochanter. The new technique was evaluated by comparing the instant, long-term and functional outcomes of the 2 groups. Results All the patients of the 2 groups obtained an average follow-up of 25. 5 months (from 12 to 36 months). The average impending avulsion angle was 42. 0°± 8. 2° in the study group compared with 35. 0°± 5. 7° in the control group ( P < 0. 05). Three months after operation, the capsular replenishing rate was 72.3% (128/177) in the study group versus 53. 3% (80/150) in the control group ( P < 0. 05); the bone mineral density was 1. 535 ±0. 020 g/cm2 in the study group compared to 0. 811 ±0. 148 g/cm2 in the control group ( P < 0. 05). At the last follow-up,no significant difference was found in Harris scores between the 2 groups (89. 7 ±5. 9 versus 91. 4 ± 11. 5, P >0. 05), but significant difference was found in Oxford Hip Score between the 2 groups(53. 2 ±0. 8 versus 45. 4 ± 1. 6, P < 0. 05). Conclusion The modified posterior repair via per-subperiosteal stripping and reattaching a periosteum-tendon-capsular compound tissue flap can result in more satisfactory outcomes in integrity, stability, healing pattern and function of the hip, because it is a combination of elastic endpoint repair and bony union.