BJJ:外侧入路半髋置换时关节囊到底要不要缝?

2015-01-22 紫川秀第二 童勇骏 丁香园

临床文献报道,目前每年股骨近端发生骨折的人数在160万左右,其中部分患者为股骨颈移位性骨折,对这类骨折,NICE推荐依据患者合并的内科情况及精神状态选择半髋或全髋置换。 半髋和全髋置换术都有术后脱位的风险,概率从1%到10%不等。半髋关节置换术后的其他因素,如下肢长度,股骨颈的代偿角度,软组织张力等均会对半髋置换术后的关节稳定性有所影响。 半髋关节置换通常采用外侧入路,很多医生习惯

临床文献报道,目前每年股骨近端发生骨折的人数在160万左右,其中部分患者为股骨颈移位性骨折,对这类骨折,NICE推荐依据患者合并的内科情况及精神状态选择半髋或全髋置换。

半髋和全髋置换术都有术后脱位的风险,概率从1%到10%不等。半髋关节置换术后的其他因素,如下肢长度,股骨颈的代偿角度,软组织张力等均会对半髋置换术后的关节稳定性有所影响。

半髋关节置换通常采用外侧入路,很多医生习惯切除前方的关节囊,理由是前方关节囊切除后方便手术操作,暴露髋臼和脱位股骨头,并在安放股骨头时减少关节囊嵌顿;在术后也可以减少因保留关节囊而造成的术后关节囊撞击。

但有学者研究了全髋关节置换后侧入路中,比较关节囊切除和关节囊+短外旋肌群重建的病例,发现修复上述结构后,患者术后的脱位比例降低。目前临床上尚无文献证实在半髋关节置换中保留关节囊或进行关节囊重建可以获得好处,为此A.W.Hughes等人进行了尸体学研究,发现,对半髋关节置换术的尸体标本,重建关节囊可以降低脱位概率。相关文章发表在BJJ杂志上。

作者共收集5具尸体标本,在室温下解冻,共10个髋关节进行研究。采用Thompson半髋关节骨水泥假体,外侧入路置换。置换完成后,将尸体标本仰卧位,离断膝关节,在离断股骨部位通过三枚钢针及一个铁环和一电子化扭力装置相连接(图1),通过扭力装置对髋关节施加外旋及伸直力量,模拟髋关节前脱位暴力。

每例髋关节脱位试验进行两次,分别为:关节囊修复和关节囊不修复。

图1.jpg

图1:研究使用的扭力装置

记录扭力装置上记录的扭力力矩峰值和平均值,关节囊修复组平均脱位扭矩为22.96Nm,关节囊无修复组,平均脱位扭矩为5.6Nm,两组的扭力数值比较有显著差异,而比较髋关节脱位时的角度也有类似的结论。

由此作者认为,和全髋关节置换术修复关节囊能降低髋关节脱位概率一样,在半髋关节置换外侧入路中,保留关节囊并行关节囊修复的尸体可以降低前脱位的力量,这也从一定程度上提示在人活体中也应该有相类似的作用,即半髋置换术中修复关节囊可以降低髋关节前脱位的脱位概率。

原始出处:

Hughes AW1, Clark D2, Carlino W3, Gosling O4, Spencer RF5.Capsule repair may reduce dislocation following hip hemiarthroplasty through a direct lateral approach: a cadaver study.Bone Joint J. 2015 Jan;97-B(1):141-4. doi: 10.1302/0301-620X.97B1.34038.

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    2015-05-28 yxch48
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    2015-04-12 x35042875

    患OS这个疾病的高风险人群提供干预措施以避免不良预后和机械治疗措施

    0

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    2015-02-19 orthoW

    ?学习了

    0