Shi Bo, Xie Ming-Rui, Li Zong-Yuan
Department of Orthopaedics, Mianyang Central Hospital, Mianyang 621000, Sichuan, China;
Department of Orthopaedics, Mianyang Central Hospital, Mianyang 621000, Sichuan, China.
Zhongguo Gu Shang. 2017 Apr 25;30(4):313-317. doi: 10.3969/j.issn.1003-0034.2017.04.006.
To evaluate the efficacy of capsular-enhanced repair with suture anchors in bipolar hemiarthroplasty for the treatment of femoral neck fractures in elderly patients.
A retrospective study was designed. From June 2009 to June 2016, 53 senile patients (54 hips)with femoral neck fracture were treated operatively in Mianyang central hospital (Sichuan, China). There were 21 males and 32 females, ranging in age from 80 to 97.5 years old (mean, 84.7 years old). There were 11 hips of Garden type II, 26 hips of Garden type III and 17 hips of Garden type IV. All the patients underwent bipolar hemiarthroplasty with enhanced repair of hip capsular. The hip joint was opened by a T shaped incision over posterior capsule. The posterior hip capsular and short external rotators were repaired particularly after the bipolar prostheses were implanted. Surgical time, intra-operative blood loss, mean hospitalization time, deep venous thrombosis, mortality, hip dislocation, pain, periprosthetic fracture, and other complications were recorded. The functional outcome was evaluated using the Harris Hip Score at the last follow-up.
The 53 patients (54 hips) were evaluated during the hospitalization period and a mean follow-up period of 11.5 months(ranged, 3 to 36 months). No dislocation, incision infection and periprosthetic fracture appeared in this group. The mean surgical time was 65 minutes(ranged, 50 to 95 min). The mean intra-operative blood loss was 213 ml(ranged, 100 to 420 ml) and the mean hospitalization time was 13.3 days(ranged, 5 to 27 days). Two patients with deep vein thrombosis, one patient with pulmonary embolism and 10 patients with venous plexus thrombosis of calf muscle were diagnosed postoperatively. The rate of venous thrombosis was 24.53% (13/53). The patient with pulmonary embolism died 8 days after operation and the other 3 patients died from heart failure 4, 6 and 7 months after operation respectively. The mortality during first year after hemiarthroplasty was 7.55% (4/53). At the latest follow-up, 42 patients (43 hips)had no pain, 9 patients had mild pain, and 2 patients had moderate pain. No patients were non-ambulatory. The mean Harris Hip Score was 91.25±8.39, functional outcome was excellent in 44 hips, good in 5, and fair in 5.
The bipolar hemiarthroplasty with capsular-enhanced repair with suture anchors is effective in reducing postoperative complications of prosthesis dislocation.
评估采用缝线锚钉进行关节囊增强修复的双极半髋关节置换术治疗老年股骨颈骨折的疗效。
设计一项回顾性研究。2009年6月至2016年6月，绵阳市中心医院（中国四川）对53例老年股骨颈骨折患者（54髋）进行了手术治疗。其中男性21例，女性32例，年龄80至97.5岁（平均84.7岁）。GardenⅡ型11髋，GardenⅢ型26髋，GardenⅣ型17髋。所有患者均接受双极半髋关节置换术并增强修复髋关节囊。经后关节囊上方的T形切口打开髋关节。在植入双极假体后，特别修复髋关节后关节囊和短外旋肌。记录手术时间、术中出血量、平均住院时间、深静脉血栓形成、死亡率、髋关节脱位、疼痛、假体周围骨折及其他并发症。末次随访时采用Harris髋关节评分评估功能结果。
53例患者（54髋）在住院期间及平均11.5个月（3至36个月）的随访期内接受评估。该组未出现脱位、切口感染及假体周围骨折。平均手术时间为65分钟（50至95分钟）。平均术中出血量为213毫升（100至420毫升），平均住院时间为13.3天（5至27天）。术后诊断出2例深静脉血栓形成患者、1例肺栓塞患者和10例小腿肌肉静脉丛血栓形成患者。静脉血栓形成率为24.53%（13/53）。肺栓塞患者术后8天死亡，其他3例患者分别于术后4、6和7个月死于心力衰竭。半髋关节置换术后第一年的死亡率为7.55%（4/53）。在末次随访时，42例患者（43髋）无疼痛，9例患者有轻度疼痛，2例患者有中度疼痛。无患者不能行走。平均Harris髋关节评分为91.25±8.39，44髋功能结果为优，5髋为良，5髋为中。
采用缝线锚钉进行关节囊增强修复的双极半髋关节置换术可有效减少假体脱位的术后并发症。
