CAJ | 학술논문

目的：探讨关节囊修复与否对新鲜股骨颈骨折患者经改良直接外侧入路初次行人工全髋关节置换术(totalhiparthroplasty，THA)术后髋关节功能的影响。方法回顾性分析2007年1月至2010年6月，经改良直接外侧入路初次行THA的新鲜股骨颈骨折患者128例，根据是否修复前方关节囊分为A、B两组。关节囊修复组(n＝61)术中修复前方关节囊；关节囊切除组(n＝67)术中切除前方关节囊，比较并分析各组患者术中出血量、引流量、术后早期髋关节脱位发生率、Harris 评分、术后髋关节早期、后期内外旋功能。结果比较两组患者性别、年龄、骨折原因、病程、骨折类型、合并内科疾病、假体选择等一般资料，差异均无统计学意义( P＞0.05)，具有可比性。各组手术时间、术中出血量及引流量比较差异均无统计学意义( F＝0.78，0.19，1.73；P＞0.05)。术后6周及6、12个月，各组Harris评分均较术前显著改善(关节囊修复组：t＝43.08，48.71，50.20；关节囊切除组：t＝41.50，44.30，53.28；P＜0.05)；组间比较显示，术后6周及6个月，关节囊修复组评分显著高于关节囊切除组，差异有统计学意义( F＝438.45，228.70；P＜0.05)；术后12个月两组比较差异无统计学意义( F＝3.22，P＞0.05)。A、B 两组患髋内、外旋范围各时间点相比较，差异无统计学意义( F＝0.01，1.47，0.14；F＝0.57，0.58，0.24；P＞0.05)，各组术后6、12个月与术后6周相比较，差异有统计学意义( t＝28.10，20.62；t＝19.45，19.82；t＝27.22，20.72；t＝17.71，15.43；P＜0.05)。结论新鲜股骨颈骨折患者经改良直接外侧入路初次行THA可以提高患髋Harris评分，有利于术后早期髋关节功能的恢复，建议术中常规保留并修复关节囊。
목적：탐토관절낭수복여부대신선고골경골절환자경개량직접외측입로초차행인공전관관절치환술(totalhiparthroplasty，THA)술후관관절공능적영향。방법회고성분석2007년1월지2010년6월，경개량직접외측입로초차행THA적신선고골경골절환자128례，근거시부수복전방관절낭분위A、B량조。관절낭수복조(n＝61)술중수복전방관절낭；관절낭절제조(n＝67)술중절제전방관절낭，비교병분석각조환자술중출혈량、인류량、술후조기관관절탈위발생솔、Harris 평분、술후관관절조기、후기내외선공능。결과비교량조환자성별、년령、골절원인、병정、골절류형、합병내과질병、가체선택등일반자료，차이균무통계학의의( P＞0.05)，구유가비성。각조수술시간、술중출혈량급인류량비교차이균무통계학의의( F＝0.78，0.19，1.73；P＞0.05)。술후6주급6、12개월，각조Harris평분균교술전현저개선(관절낭수복조：t＝43.08，48.71，50.20；관절낭절제조：t＝41.50，44.30，53.28；P＜0.05)；조간비교현시，술후6주급6개월，관절낭수복조평분현저고우관절낭절제조，차이유통계학의의( F＝438.45，228.70；P＜0.05)；술후12개월량조비교차이무통계학의의( F＝3.22，P＞0.05)。A、B 량조환관내、외선범위각시간점상비교，차이무통계학의의( F＝0.01，1.47，0.14；F＝0.57，0.58，0.24；P＞0.05)，각조술후6、12개월여술후6주상비교，차이유통계학의의( t＝28.10，20.62；t＝19.45，19.82；t＝27.22，20.72；t＝17.71，15.43；P＜0.05)。결론신선고골경골절환자경개량직접외측입로초차행THA가이제고환관Harris평분，유리우술후조기관관절공능적회복，건의술중상규보류병수복관절낭。
Objective To investigate the impact of joint capsule reconstruction on the functional prognosis in primary total hip arthroplasty ( THA ) by a modiifed direct lateral approach for the patients with fresh femoral neck fractures.Methods From January 2007 to June 2010, the clinical data of 128 patients with fresh femoral neck fractures who underwent primary THA by the modified direct lateral approach were retrospectively analyzed. According to whether the repair of anterior joint capsule was performed, the patients were divided into group A and group B. In group A (n=61 ) the patients underwent the repair of anterior joint capsule, and in group B (n=67 ) the resection of anterior joint capsule was performed. The intraoperative blood loss and drainage volume, early postoperative incidence of hip dislocation, Harris hip score and early and later postoperative hip range of motion ( ROM ) in internal and external rotation were compared and analyzed between the 2 groups.Results The general data were compared between the 2 groups, including the gender, age, cause of fractures, disease course, fracture type, combined medical disorders, prosthesis selection and so on. The results were comparable, but no statistically signiifcant differences existed (P>0.05 ). There were no statistically signiifcant differences in the operation time, intraoperative blood loss or drainage volume between the 2 groups (F=0.78, 0.19, 1.73;P>0.05 ). The Harris hip scores were signiifcantly improved at 6, 24 and 48 weeks after the operation when compared with the preoperative scores in both groups (t=43.08, 48.71, 50.20 in group A;t=41.50, 44.30, 53.28 in group B;P<0.05 ). At 6 and 24 weeks after the operation, the scores in group A were signiifcantly higher than that in group B and the differences between them were statistically signiifcant (F=438.45, 228.70;P<0.05 ). However, no statistically significant differences were noticed at 12 months after the operation (F=3.22,P>0.05 ). There were no statistically significant differences in the hip ROM in internal and external rotation at different time points between group A and group B (F=0.01, 1.47, 0.14;F=0.57, 0.58, 0.24;P>0.05). The differences in the hip ROM in internal and external rotation at 6 and 12 months after the operation and at 6 weeks after the operation were statistically signiifcant (t=28.10, 20.62;t=19.45, 19.82;t=27.22, 20.72;t=17.71, 15.43;P<0.05 ). Conclusions Primary THA by the modiifed direct lateral approach is recommended for the patients with fresh femoral neck fractures, and the Harris hip scores can be improved and the early postoperative hip function can be restored. The joint capsule should be reserved and repaired conventionally during the operation.