股骨颈骨折全髋关节置换是否缝合后关节囊的比较△（开放获取）

Total hip arthroplasty with or without capsule repair for femoral neck fractures

摘要:

[目的]比较股骨颈骨折后外侧入路全髋关节置换（totalhiparthroplasty,THA）是否缝合后关节囊预防髋关节脱位的临床疗效。[方法]回顾性分析2019年1月—2022年12月收治的191例经后外侧入路行THA的股骨颈骨折患者的临床资料。 根据术前医患沟通结果，93例THA后行关节囊荷包缝合（缝合组），98例THA后未缝合关节囊，外旋短肌给予传统重建（传统组）。比较两组围手术期、随访和影像资料。[结果]缝合组术后24h引流量[(180.2±66.8)mLvs(209.7±70.7)mL,P=0.004]显著少于传统组，两组手术时间、切口总长度、术中失血量、下地行走时间、住院期间脱位、住院时间的差异无统计学意义（P＞ 0.05）。随访时间平均（15.3±4.3）个月。缝合组出院后脱位率[0vs5.1%,P=0.027]显著低于传统组。随时间推移，两组VAS评分、Harris评分、髋伸-屈及内-外旋ROM均显著改善（P＜0.05），术后1个月缝合组VAS评分[(5.2±1.2) vs (4.7±1.4),P= 0.009]、Harris评分[(64.7±5.6)vs(69.3±4.8),P＜0.001]、髋伸-屈[(77.1±5.9)°vs(78.8±5.7)°,P=0.044]及内-外旋ROM[(46.2±4.5)° vs(47.5±4.0)°,P=0.036]均不及传统组。影像方面，末次随访均未见假体松动，两组髋臼外展角、前倾角、双股骨长度差的差异均无统计学意义（P＞0.05）。[结论]后关节囊荷包缝合能降低股骨颈骨折后外侧入路THA的脱位率。

Abstract:

[Objective] To compare the clinical efficacy of prevention of hip dislocation in total hip arthroplasty (THA) with or without capsule repair through posterolateral approach for femoral neck fractures. [Methods] A retrospective study was conducted on 191 patients who underwent THA through the posterolateral approach for femoral neck fractures from January 2019 to December 2022. According to preoperative doctor-patient communication, 93 patients had the joint capsular repaired with a pouch suture after THA (the sutured group), while other 98 patients underwent THA without the capsule repaired, withe traditional rotator insertion reconstructed only (the traditional group). The perioperative, follow-up and imaging data of the two groups were compared. [Results] The sutured group had significantly less drainage volume 24 hours postoperatively than the traditional group [(180.2±66.8) mL vs (209.7±70.7) mL, P 0.004], although there were no significant differences in operation time, total incision length, intraoperative blood loss, walking time, dislocation occurred during hospitalization and hospital stay between the two groups (P＞0.05). The average follow-up period lasted for (15.3±4.3) months, and the sutured group proved significantly low hip dislocation incidence after discharge than the traditional group [0 vs 5.1%, P 0.027]. As time went on, the VAS score, Harris score, hip extension-flexion and internal-external rotation ROMs were significantly improved in both groups (P＜ 0.05), The sutured group proved significantly inferior to the traditional group in terms of VAS score [(5.2±1.2) vs (4.7±1.4), P=0.009], Harris score [(64.7±5.6) vs (69.3±4.8), P 0.001], extension-flexion ROM [(77.1±5.9)° vs (78.8±5.7)°, P=0.044] and internal-external rotation ROM [(46.2±4.5)° vs (47.5±4.0)°, P 0.036] 1 month postoperatively, whereas which became not statistically significant between them later (P＞0.05). As for imaging, no prosthesis loosening was observed in anyone of them, and there were no significant differences in acetabular abduction angle, anterior inclination and leg length discrepancy between the two groups at the last follow-up (P＞0.05). [Conclusion] The pouch suture for capsule repair does reduce the hip dislocation chance after THA through the posterolateral approach for femoral neck fractures