[1]石少辉,吴国平,文海昭,等.改良外旋肌重建在老年股骨颈骨折患者后外侧入路髋关节置换术中的应用[J].新乡医学院学报,2017,34(1):065-68.[doi:10.7683/xxyxyxb.2017.01.019]
　SHI Shao-hui,WU Guo-ping,WEN Hai-zhao,et al.Application of modified external rotator reconstruction in hip arthroplasty through posterolateral approach in elderly patients with femoral neck fractures[J].Journal of Xinxiang Medical University,2017,34(1):065-68.[doi:10.7683/xxyxyxb.2017.01.019]
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改良外旋肌重建在老年股骨颈骨折患者后外侧入路髋关节置换术中的应用
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
34
期数:
2017年1
页码:
065-68
栏目:
临床研究
出版日期:
2017-01-05

文章信息/Info

Title:
Application of modified external rotator reconstruction in hip arthroplasty through posterolateral approach in elderly patients with femoral neck fractures
作者:
石少辉; 吴国平; 文海昭; 王保西; 李海啸; 曹三利
（航空总医院骨科中心，北京　100012）
Author(s):
SHI Shao-hui; WU Guo-ping; WEN Hai-zhao; WANG Bao-xi; LI Hai-xiao; CAO San-li
（Department of Orthopaedic Surgey，General Aviation Hospital，Beijing 100012，China）
关键词:
老年; 髋关节置换; 外旋肌重建; 再次撕裂; 关节脱位
Keywords:
elderly; hip arthroplasty; external rotator reconstruction; tear; dislocation
分类号:
R683
DOI:
10.7683/xxyxyxb.2017.01.019
文献标志码:
A
摘要:
目的　探讨老年股骨颈骨折患者后外侧入路行髋关节置换时，采用改良方法用带线锚钉原位重建外旋肌群对预防髋关节后脱位的临床意义。方法　选取航空总医院2011年1月至2015年6月因股骨颈骨折住院患者151例，其中2011年1月至2013年5月股骨颈骨折住院患者86例采用传统的外旋肌群重建方法（对照组），2013年6月至2015年6月股骨颈骨折住院患者65例采用改良的外旋肌群重建方法（观察组），2组患者均为新发生骨折，且在入院后3～7 d内行髋关节置换术。观察组患者术中分离外旋肌群时，紧贴外旋肌止点处用电凝离断，关节置换后用锚钉缝合线将外旋肌原位缝合至股骨大转子止点处；对照组患者距离止点0.5～1.0 cm切断外旋肌，用1-0可吸收缝线于大转子处重建。2组患者重建外旋肌群后，术中活动髋关节观察是否引起重建处撕裂，并对术后髋关节假体脱位及髋关节功能等情况进行比较。2组患者术后均随访12个月。结果　观察组患者未发生术中外旋肌重建后撕裂及术后关节脱位现象；对照组13例患者术中发生重建外旋肌撕裂，其中6例发生术后假体脱位；对照组患者发生术中外旋肌重建后撕裂及术后关节脱位发生率显著高于观察组（χ2=10.751，P=0.001；χ2=4.723，P=0.030）。术后12个月随访结果显示，观察组患者外旋肌肌力达3级以上者占92.31%（60/65），髋关节Harris评分为84.5±9.2；对照组患者外旋肌肌力达3级以上者占79.07%（68/86），Harris 评分71.9±8.4；观察组患者外旋肌肌力达3级以上者比例及Harris评分均显著高于对照组（χ2=5.024，P=0.025；t=3.124，P=0.001）。结论　改良外旋肌重建是预防老年股骨颈骨折患者后外侧入路髋关节置换术后假体脱位的有效方法。
Abstract:
Objective　To observe the effect of modified external rotator reconstruction in situ with anchor thread in prevention of hip dislocation in elderly femoral neck fracture patients who underwent hip arthroplasty through posterolateral approach.Methods　One hundred and fifty-one patients with femoral neck fractures in General Aviation Hospital from January 2011 to June 2015 were selected.Among them，86 patients who underwent traditional external rotator reconstruction from January 2011 to May 2013 were picked out as control group；another 65 patients who underwent modified external rotator reconstruction from June 2013 to June 2015 were picked out as observation group.All patients were new fracture，and they underwent hip arthroplasty within 3-7 days after fracture.When dissected the external rotators of patients in observation group，the electric condensate must be close to the junction of external rotator；the external rotators was sutured to the greater trochanter of femur in situ with anchor thread after hip replacement.The external rotators of patients in control group was dissected within 0.5-1.0 cm stump from the greater trochanter，and then was sutured to the greater trochanter of femur with 1-0 absorbable suture.After rebuilding the external rotators，the affected hip was moved passively to observe whether the reconstruction tear again，and compared the dislocation and function of hip postoperative in all patients.All patients were followed up for 12 months.Results　There was no patients with postoperative hip dislocation and reconstructed external rotators tearing in observation group.There were 13 patients occurred reconstructed external rotators tearing in control group，among them，6 patients with postoperative hip dislocation.The incidences of the reconstructed external rotators tearing and postoperative hip dislocation were significantly higher than that in the observation group（χ2=10.751，P=0.001；χ2=4.723，P=0.030）.After 12 months follow-up，the strength of external rotator more than three degree in observation group and control group was 92.31% （60/65）and 79.07%（68/86）；the Harris score of patients in observation group and control group was 84.5±45.1 and 71.9±8.4；the strength of external rotator more than three degree and Harris score of patients in observation group were significanlty higher than those in the control group（χ2=5.024，P=0.025；t=3.124，P=0.001）.Conclusion　Modified external rotator reconstruction can effectively prevent hip dislocation in hip arthroplasty through posterolateral approach in elderly femoral neck fracture patients with.

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更新日期/Last Update: 2017-01-05