Zhao Yong, Liu Kegui, Sun Tao, Zhao Yuchi, Zou Dexin, Tan Jiangwei, Li Jingning, Zhang Shudong, Liu Yangde
Department of Orthopedics, Yantai Shan Hospital, Yantai 264008, China. Email:
Department of Orthopedics, Yantai Shan Hospital, Yantai 264008, China.
Zhonghua Yi Xue Za Zhi. 2014 Dec 9;94(45):3567-70.
To summarize our experiences of applying percutaneous multiple needle puncturing technique for releasing adductor muscle during total hip arthroplasty (THA) for ischemic necrosis of femoral head and provide rationales for clinical practice.
From January 2008 to December 2012, 36 adult patients with ischemic necrosis of femoral head (36 hips) and 36 adult patients with femoral neck fracture (36 hips) were recruited. The group of ischemic necrosis of femoral head was designated as experiment group in which there were 29 males and 7 females with an average age of 67.9 (60-78) years. According to the Ficat system, there were type III (n = 24) and type IV (n = 12) . The affected leg shortening of this group prior to surgery was over 2 cm. The group of femoral neck fracture was selected as control group in which there were 16 males and 20 females with an average age of 70.1 (60-82) years. According to the Garden system, there were type III (n = 16) and type IV (n = 20). All cases underwent THA with Press-fit prosthesis. After fixing prosthetic components, leg length discrepancy was corrected. And percutaneous multiple needle puncturing was applied for releasing adductor muscle in experiment group. The follow-up period was 2 years. The safety and efficiency were evaluated by HHS (Harris Hip Score) and the range of motion (ROM) of hip extorsion and abduction.
There was no occurrence of such early complications as palsy of obturator nerve, hematoma in adductor muscle area or serious deep vein embolism.No serious complications of deep infection, femoral head dislocation, recurrent adductor muscle contracture, prosthesis loosening, subsidence, excursion or penetration occurred up until the final follow-up. The range of hip motion of extorsion and abduction: (1) in experimental group, the postoperative ROM (abduction:44.9 ± 0.8, extorsion:45.1 ± 0.9) was significantly larger than that of preoperative (abduction: 30.0 ± 4.6, extorsion:31.5 ± 4.6) ; (2) the postoperative ROM of experimental group had no significant changes until the final follow-up (abduction: 44.7 ± 0.9, extorsion:45.25 ± 0.81); (3) at the last time of follow-up, no significant inter-group difference existed in ROM (abduction:44.86 ± 0.68, extorsion:45.6 ± 0.8). HHS: (1) in experimental group, HHS increased significantly from 39.64 ± 3.93 preoperatively to 82.8 ± 3.6 at 3 months postoperatively; (2) in two groups, HHS of 2 years postoperation (experimental group: 88.6 ± 4.1, control group: 89.1 ± 4.0) was significantly larger than that of 3 months postoperation (experimental group: 82.8 ± 3.6, control group:83.1 ± 3.1); (3) at the time of 3 months and 2 years postoperation, no significant inter-group difference existed in HHS.
The technique percutaneous multiple needle puncturing for releasing adductor muscle during THA for ischemic necrosis of femoral head is both safe and efficacious. And it solves the problems of soft tissue balancing mini-invasiveness.
总结在股骨头缺血性坏死全髋关节置换术（THA）中应用经皮多针穿刺技术松解内收肌的经验，为临床实践提供依据。
选取2008年1月至2012年12月期间的36例成年股骨头缺血性坏死患者（36髋）和36例成年股骨颈骨折患者（36髋）。将股骨头缺血性坏死组设为试验组，其中男性29例，女性7例，平均年龄67.9（60 - 78）岁。根据Ficat系统，Ⅲ型24例，Ⅳ型12例。该组术前患侧下肢短缩超过2 cm。将股骨颈骨折组作为对照组，其中男性16例，女性20例，平均年龄70.1（60 - 82）岁。根据Garden系统，Ⅲ型16例，Ⅳ型20例。所有病例均采用压配式假体行THA。固定假体组件后，纠正肢体长度差异。试验组采用经皮多针穿刺松解内收肌。随访2年。通过Harris髋关节评分（HHS）及髋关节后伸和外展活动范围（ROM）评估安全性和有效性。
未发生闭孔神经麻痹、内收肌区血肿或严重深静脉栓塞等早期并发症。直至末次随访，未出现深部感染、股骨头脱位、内收肌挛缩复发、假体松动、下沉、移位或穿透等严重并发症。髋关节后伸和外展活动范围：（1）试验组术后ROM（外展：44.9±0.8，后伸：45.1±0.9）明显大于术前（外展：30.0±4.6，后伸：31.5±4.6）；（2）试验组术后ROM至末次随访无明显变化（外展：44.7±0.9，后伸：45.25±0.81）；（3）末次随访时，两组ROM无明显组间差异（外展：44.86±0.68，后伸：45.6±0.8）。HHS：（1）试验组HHS由术前的39.64±3.93显著提高至术后3个月的82.8±3.6；（2）两组术后2年HHS（试验组：88.6±4.1，对照组：89.1±4.0）明显大于术后3个月（试验组：82.8±3.6，对照组：83.1±3.1）；（3）术后3个月和2年时，两组HHS无明显组间差异。
在股骨头缺血性坏死THA中应用经皮多针穿刺松解内收肌技术安全有效。且解决了软组织平衡及微创问题。
