CAJ | 학술논문

目的：观察人工全髋关节置换术（ THA）术中使用经皮多针刺技术对紧张挛缩的内收肌进行松解的疗效。方法自2008年1月至2012年12月，烟台市烟台山医院骨科治疗股骨头缺血性坏死和股骨颈骨折各36例。股骨头坏死塌陷组为研究组，男29例，女7例，平均年龄67．9（60～78）岁；Ficat分期，Ⅲ期24例，Ⅳ期12例；患者术前患肢短缩均≥2 cm。股骨颈骨折组为对照组，男16例，女20例，平均年龄70．1（60～82）岁；Garden分型，Ⅲ型16例，Ⅳ型20例。所有病例均接受压配型THA治疗，术中达到双下肢等长，研究组THA术中使用经皮多针刺技术松解内收肌。术后随访2年。通过髋关节外展外旋活动度和HHS评分等指标对多针刺松解的有效性和安全性进行评估。结果所有病例术后均未出现闭孔神经麻痹征象，研究组术后内收肌区域无血肿。两组术后2d、1周均无严重的深静脉血栓出现。直至最终随访时，所有病例均没有深部感染、髋关节脱位、复发性内收肌挛缩、假体松动、下沉、穿破皮质等重大合并症出现。髋关节外展外旋活动度比较，研究组术后[外展（44．9±0．8）°，外旋（45．1±0．9）°]较术前[外展（30．0±4．6）°，外旋（31．5±4．6）°]明显增大；研究组术后直至末次随访[外展（44．7±0．9）°，外旋（45．3±0．8）°]均无显著变化；研究组和对照组[外展（44．9±0．7）°，外旋（45．6±0．8）°]的末次随访差异无统计学意义。 HHS评分比较，研究组术后3个月较术前明显增大[（82．8±3．6）°比（39．6±3．9）°]；两组的术后2年[研究组（88．6±4．1）°，对照组（89．1±4．0）°]均较术后3个月[研究组（82．8±3．6）°，对照组（83．1±3．1）°]明显增大；术后3个月和术后2年时，研究组与对照组之间差异均无统计学意义。结论经皮多针刺松解内收肌，在合并塌陷的股骨头坏死THA术中是安全、有效的，有助于微创而安全地解决软组织平衡问题。目的：觀察人工全髖關節置換術（ THA）術中使用經皮多針刺技術對緊張攣縮的內收肌進行鬆解的療效。方法自2008年1月至2012年12月，煙檯市煙檯山醫院骨科治療股骨頭缺血性壞死和股骨頸骨摺各36例。股骨頭壞死塌陷組為研究組，男29例，女7例，平均年齡67．9（60～78）歲；Ficat分期，Ⅲ期24例，Ⅳ期12例；患者術前患肢短縮均≥2 cm。股骨頸骨摺組為對照組，男16例，女20例，平均年齡70．1（60～82）歲；Garden分型，Ⅲ型16例，Ⅳ型20例。所有病例均接受壓配型THA治療，術中達到雙下肢等長，研究組THA術中使用經皮多針刺技術鬆解內收肌。術後隨訪2年。通過髖關節外展外鏇活動度和HHS評分等指標對多針刺鬆解的有效性和安全性進行評估。結果所有病例術後均未齣現閉孔神經痳痺徵象，研究組術後內收肌區域無血腫。兩組術後2d、1週均無嚴重的深靜脈血栓齣現。直至最終隨訪時，所有病例均沒有深部感染、髖關節脫位、複髮性內收肌攣縮、假體鬆動、下沉、穿破皮質等重大閤併癥齣現。髖關節外展外鏇活動度比較，研究組術後[外展（44．9±0．8）°，外鏇（45．1±0．9）°]較術前[外展（30．0±4．6）°，外鏇（31．5±4．6）°]明顯增大；研究組術後直至末次隨訪[外展（44．7±0．9）°，外鏇（45．3±0．8）°]均無顯著變化；研究組和對照組[外展（44．9±0．7）°，外鏇（45．6±0．8）°]的末次隨訪差異無統計學意義。 HHS評分比較，研究組術後3箇月較術前明顯增大[（82．8±3．6）°比（39．6±3．9）°]；兩組的術後2年[研究組（88．6±4．1）°，對照組（89．1±4．0）°]均較術後3箇月[研究組（82．8±3．6）°，對照組（83．1±3．1）°]明顯增大；術後3箇月和術後2年時，研究組與對照組之間差異均無統計學意義。結論經皮多針刺鬆解內收肌，在閤併塌陷的股骨頭壞死THA術中是安全、有效的，有助于微創而安全地解決軟組織平衡問題。
목적：관찰인공전관관절치환술（ THA）술중사용경피다침자기술대긴장련축적내수기진행송해적료효。방법자2008년1월지2012년12월，연태시연태산의원골과치료고골두결혈성배사화고골경골절각36례。고골두배사탑함조위연구조，남29례，녀7례，평균년령67．9（60～78）세；Ficat분기，Ⅲ기24례，Ⅳ기12례；환자술전환지단축균≥2 cm。고골경골절조위대조조，남16례，녀20례，평균년령70．1（60～82）세；Garden분형，Ⅲ형16례，Ⅳ형20례。소유병례균접수압배형THA치료，술중체도쌍하지등장，연구조THA술중사용경피다침자기술송해내수기。술후수방2년。통과관관절외전외선활동도화HHS평분등지표대다침자송해적유효성화안전성진행평고。결과소유병례술후균미출현폐공신경마비정상，연구조술후내수기구역무혈종。량조술후2d、1주균무엄중적심정맥혈전출현。직지최종수방시，소유병례균몰유심부감염、관관절탈위、복발성내수기련축、가체송동、하침、천파피질등중대합병증출현。관관절외전외선활동도비교，연구조술후[외전（44．9±0．8）°，외선（45．1±0．9）°]교술전[외전（30．0±4．6）°，외선（31．5±4．6）°]명현증대；연구조술후직지말차수방[외전（44．7±0．9）°，외선（45．3±0．8）°]균무현저변화；연구조화대조조[외전（44．9±0．7）°，외선（45．6±0．8）°]적말차수방차이무통계학의의。 HHS평분비교，연구조술후3개월교술전명현증대[（82．8±3．6）°비（39．6±3．9）°]；량조적술후2년[연구조（88．6±4．1）°，대조조（89．1±4．0）°]균교술후3개월[연구조（82．8±3．6）°，대조조（83．1±3．1）°]명현증대；술후3개월화술후2년시，연구조여대조조지간차이균무통계학의의。결론경피다침자송해내수기，재합병탑함적고골두배사THA술중시안전、유효적，유조우미창이안전지해결연조직평형문제。
Objective To summarize our experiences of applying percutaneous multiple needle puncturing technique for releasing adductor muscle during total hip arthroplasty ( THA) for ischemic necrosis of femoral head and provide rationales for clinical practice.Methods From January 2008 to December 2012, 36 adult patients with ischemic necrosis of femoral head (36 hips) and 36 adult patients with femoral neck fracture (36 hips) were recruited.The group of ischemic necrosis of femoral head was designated as experiment group in which there were 29 males and 7 females with an average age of 67.9 ( 60 -78 ) years.According to the Ficat system, there were typeⅢ(n=24) and type Ⅳ (n=12).The affected leg shortening of this group prior to surgery was over 2 cm.The group of femoral neck fracture was selected as control group in which there were 16 males and 20 females with an average age of 70.1 ( 60 -82 ) years.According to the Garden system, there were type Ⅲ ( n =16 ) and type Ⅳ ( n =20 ) .All cases underwent THA with Press-fit prosthesis.After fixing prosthetic components, leg length discrepancy was corrected.And percutaneous multiple needle puncturing was applied for releasing adductor muscle in <br> experiment group.The follow-up period was 2 years.The safety and efficiency were evaluated by HHS ( Harris Hip Score) and the range of motion ( ROM) of hip extorsion and abduction.Results There was no occurrence of such early complications as palsy of obturator nerve, hematoma in adductor muscle area or serious deep vein embolism.No serious complications of deep infection, femoral head dislocation, recurrent adductor muscle contracture, prosthesis loosening, subsidence, excursion or penetration occurred up until the final follow-up.The range of hip motion of extorsion and abduction:( 1 ) in experimental group, the postoperative ROM ( abduction:44.9 ±0.8, extorsion:45.1 ±0.9) was significantly larger than that of preoperative (abduction:30.0 ±4.6, extorsion:31.5 ±4.6); (2) the postoperative ROM of experimental group had no significant changes until the final follow-up( abduction:44.7 ±0.9, extorsion:45.25 ±0.81);(3) at the last time of follow-up, no significant inter-group difference existed in ROM( abduction:44.86 ± 0.68, extorsion:45.6 ±0.8).HHS:(1)in experimental group, HHS increased significantly from 39.64 ± 3.93 preoperatively to 82.8 ±3.6 at 3 months postoperatively; ( 2 ) in two groups, HHS of 2 years postoperation ( experimental group:88.6 ±4.1, control group:89.1 ±4.0) was significantly larger than that of 3 months postoperation(experimental group:82.8 ±3.6, control group:83.1 ±3.1);(3) at the time of 3 months and 2 years postoperation, no significant inter-group difference existed in HHS.Conclusion The technique percutaneous multiple needle puncturing for releasing adductor muscle during THA for ischemic necrosis of femoral head is both safe and efficacious.And it solves the problems of soft tissue balancing mini-invasiveness.