Hughes A W, Clark D, Carlino W, Gosling O, Spencer R F
Orthopaedic Department, Southmead Hospital, Southmead Road, Westbury-on-Trym, Bristol BS10 5NB, UK.
Bristol Royal Infirmary, Upper Maudlin Street, Bristol, UK.
Bone Joint J. 2015 Jan;97-B(1):141-4. doi: 10.1302/0301-620X.97B1.34038.
Reported rates of dislocation in hip hemiarthroplasty (HA) for the treatment of intra-capsular fractures of the hip, range between 1% and 10%. HA is frequently performed through a direct lateral surgical approach. The aim of this study is to determine the contribution of the anterior capsule to the stability of a cemented HA through a direct lateral approach. A total of five whole-body cadavers were thawed at room temperature, providing ten hip joints for investigation. A Thompson HA was cemented in place via a direct lateral approach. The cadavers were then positioned supine, both knee joints were disarticulated and a digital torque wrench was attached to the femur using a circular frame with three half pins. The wrench applied an external rotation force with the hip in extension to allow the hip to dislocate anteriorly. Each hip was dislocated twice; once with a capsular repair and once without repairing the capsule. Stratified sampling ensured the order in which this was performed was alternated for the paired hips on each cadaver. Comparing peak torque force in hips with the capsule repaired and peak torque force in hips without repair of the capsule, revealed a significant difference between the 'capsule repaired' (mean 22.96 Nm, standard deviation (sd) 4.61) and the 'capsule not repaired' group (mean 5.6 Nm, sd 2.81) (p < 0.001). Capsular repair may help reduce the risk of hip dislocation following HA.
据报道，髋关节半关节置换术（HA）治疗髋关节囊内骨折的脱位率在1%至10%之间。HA通常通过直接外侧手术入路进行。本研究的目的是通过直接外侧入路确定前关节囊对骨水泥型HA稳定性的作用。总共五具全身尸体在室温下解冻，提供十个髋关节用于研究。通过直接外侧入路将汤普森HA用骨水泥固定到位。然后将尸体仰卧放置，双膝关节离断，并使用带有三个半针的圆形框架将数字扭矩扳手连接到股骨上。扳手在髋关节伸展时施加外旋力以使髋关节向前脱位。每个髋关节脱位两次；一次进行关节囊修复，一次不修复关节囊。分层抽样确保在每具尸体上对配对的髋关节交替进行操作顺序。比较修复关节囊的髋关节的峰值扭矩力和未修复关节囊的髋关节的峰值扭矩力，发现“修复关节囊”组（平均22.96 Nm，标准差（sd）4.61）和“未修复关节囊”组（平均5.6 Nm，sd 2.81）之间存在显著差异（p < 0.001）。关节囊修复可能有助于降低HA后髋关节脱位的风险。
