Department of Orthopaedic Surgery, the Second Hospital of Dalian Medical University, Dalian, Liaoning Province, China.
Department of Orthopaedic, The Second Clinical Medical College, Dalian Medical University, Dalian, Liaoning Province, China.
J Invest Surg. 2021 May;34(5):513-521. doi: 10.1080/08941939.2019.1651922. Epub 2019 Sep 25.
Although the posterolateral approach is considered to carry a higher early dislocation rate after total hip arthroplasty, posterior soft tissue repair techniques make up for this limitation. Through-bone and through-tendon repair techniques are the two most commonly used techniques. This study aimed to comprehensively compare these techniques and give more evidence-based references for orthopedists. This retrospective study enrolled 87 patients who underwent posterior soft tissue repair with total hip arthroplasty via the posterolateral approach. The posterior capsular and external rotators were reconstructed to the greater trochanter through drill holes (through-bone, = 46) or gluteus medius tendon (through-tendon, = 41). Early dislocation rate, repair-related complications, postoperative pain (visual analog scale, VAS), hip joint function (Harris Hip Scale, HHS), patient satisfaction, and operation-related indexes were evaluated. The discrepancy in early dislocation between the two cohorts was not statistically significant. Operation-related indexes were not significantly different between the two cohorts, except for the postoperative drainage volume (229.46 mL vs. 172.07 mL, =.013). No patient sustained greater trochanteric fracture and sciatic nerve injury. Each group achieved significant improvements in HHS and VAS scores compared with preoperative values. No statistically significant discrepancy was found in HHS scores between the two groups at the same period, while VAS scores were significantly lower in the through-bone group at 1 week (4.93 vs. 5.68, =.026) and 1 month (1.72 vs. 1.99, =.038) after surgery. Higher patient satisfaction was observed in the through-bone group. Although no statistical discrepancy in the early dislocation rate between through-bone and through-tendon repair techniques was observed, lower pain scores and higher patient satisfaction supported the former. We recommend that through-bone repair technique should be chosen first by orthopedists when performing reconstruction of the posterior soft tissue in total hip arthroplasty via a posterolateral approach.
虽然后外侧入路被认为在全髋关节置换术后早期脱位率较高，但后软组织修复技术弥补了这一局限性。经骨和经肌腱修复技术是最常用的两种技术。本研究旨在全面比较这两种技术，为骨科医生提供更多循证参考。
这项回顾性研究纳入了 87 例通过后外侧入路行全髋关节置换术后行后软组织修复的患者。通过骨孔（经骨，=46）或臀中肌肌腱（经肌腱，=41）将后关节囊和外旋肌重建到大转子。评估早期脱位率、与修复相关的并发症、术后疼痛（视觉模拟评分，VAS）、髋关节功能（Harris 髋关节评分，HHS）、患者满意度和手术相关指标。
两组间早期脱位的差异无统计学意义。两组间手术相关指标无显著差异，除术后引流量（229.46ml vs. 172.07ml，=.013）外。无患者发生大转子骨折和坐骨神经损伤。两组 HHS 和 VAS 评分均较术前显著改善。同期两组 HHS 评分无统计学差异，而术后 1 周（4.93 与 5.68，=.026）和 1 个月（1.72 与 1.99，=.038）时经骨组 VAS 评分明显较低。经骨组患者满意度较高。
虽然经骨和经肌腱修复技术的早期脱位率无统计学差异，但较低的疼痛评分和较高的患者满意度支持前者。我们建议，当通过后外侧入路行全髋关节置换术后软组织重建时，骨科医生应首选经骨修复技术。
