前路股骨头置换是否修复关节囊的比较

Anterior approach femoral head replacement for femoral neck fracture with or without capsule repair

摘要:

[目的] 比较股骨颈骨折经前路股骨头置换术是否缝合关节囊的临床结果。[方法] 回顾性分析2015 年2 月—2020年6 月本院前路股骨头置换术治疗老年股骨颈骨折82 例患者的临床资料。依据术前医患沟通结果，35 例术中缝合关节囊， 47例未缝合关节囊。比较两组围手术期、随访和影像资料。[结果] 虽然缝合组手术时间显著长于未缝合组[(72.3±10.4) min vs(53.6±8.9) min, P＜0.001]，但缝合组术中失血量[(172.6±24.6) ml vs (226.3±32.5) ml, P＜0.001]、下地行走时间[(4.2±1.0) d vs (5.6±1.7) d, P＜0.001]、住院时间[(10.3±2.3) d vs (12.5±2.4) d, P＜0.001] 均显著优于未缝合组。随访12 个月以上，缝合组恢复完全负重活动显著早于未缝合组[(48.3±8.0) d vs (70.4±13.3) d, P＜0.001]。与术后6 个月相比，两组患者末次随访时疼痛VAS 评分均降低，而SF-36 评分、Harris 评分、髋伸屈ROM 均增加（P＜0.05）。末次随访时，缝合组的VAS 评分、SF-36 评分均显著优于未缝合组（P＜0.05）。影像方面，末次随访时，缝合组双侧股骨长度差显著小于未缝合组（P＜0.05）。[结论] 在股骨颈骨折经前路股骨头置换术中，缝合关节囊的做法在术中失血量、术后康复、疼痛减轻、生活质量以及髋关节功能恢复等多方面明显优于不缝合关节囊。

Abstract:

[Objective] To compare the clinical outcomes of anterior approach femoral head replacement for femoral neck fracture withor without capsule suture. [Methods] A retrospective study was conducted on 82 elderly patients who received anterior approach femoralhead replacement for femoral neck fractures in our hospital from February 2015 to June 2020. According to preoperative doctor-patientcommunication, 35 patients had capsule sutured, while other 47 patients were unsutured. The documents regarding to perioperative period,follow-up and images were compared between the two groups. [Results] Although the sutured group consumed significantly longer opera-tive time than the unsutured group [(72.3±10.4) min vs (53.6±8.9) min, P＜0.001], the former proved significantly superior to the latter interms of intraoperative blood loss [(172.6±24.6) ml vs (226.3±32.5) ml, P＜0.001], postoperative ambulation time [(4.2±1.0) days vs (5.6±1.7)days, P＜0.001] and hospital stay [(10.3±2.3) days vs (12.5±2.4) days, P＜0.001]. All patients were followed up for more than 12 months, andthe sutured group resume full weight-bearing activity significantly earlier than the unsutured group [(48.3±8.0) days vs (70.4±13.3) days, P＜0.001]. Compared with those 6 months after surgery, the pain VAS score significantly decreased (P＜0.05), while SF-36, Harris scores andhip extension -flexion ROM significantly increased in both groups at the latest follow-up (P＜0.05). At all corresponding time points, VASscore and SF-36 score in sutured group were significantly better than those in unsutured group (P＜0.05). As for imaging, the sutured groupgot significantly less bilateral femur length discrepancy than the unsutured group at the last follow-up (P＜0.05). [Conclusion] Suturing thejoint capsule is significantly better than the non-suturing regarding many factors such as intraoperative blood loss, postoperative recovery,pain relief, quality of life improvement and hip function recovery in hemiarthroplasty for femoral neck fracture.