Tetsunaga Tomonori, Tetsunaga Tomoko, Yamada Kazuki, Sanki Tomoaki, Kawamura Yoshi, Ozaki Toshifumi
Department of Orthopaedic Surgery, Okayama University Hospital.
Department of Medical Materials for Musculoskeletal Reconstruction, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences.
Acta Med Okayama. 2021 Feb;75(1):25-30. doi: 10.18926/AMO/61430.
In bipolar hemiarthroplasty (BHA), it is important to preserve soft tissue to reduce the risk of postoperative dislocation. A variety of surgical approaches for BHA are available, but extra care is needed with muscle- and tendon-preserving approaches in geriatric patients. We investigated the usefulness of BHA using a conjoined tendon-preserving posterior (CPP) approach, in which only the external obturator muscle is dissected, in geri-atric patients. We retrospectively analyzed the cases of 40 femoral neck fracture patients (10 men, 30 women) aged ≥ 80 years who underwent BHA using the CPP approach. The patients' average age was 85.8 years (80-94 years). We examined the operation time, bleeding, preservation of short external rotator muscles, complica-tions, and stem alignment and subsidence from postoperative radiographs. Although gemellus inferior muscle injury was detected in 4 patients (10%), the hip joint stability was very excellent in all cases. There was no intraoperative fracture or postoperative dislocation. On postoperative radiographs, all femoral stems were in a neutral position. There was no stem subsidence in all 40 patients. BHA using the CPP approach appeared to be useful even in geriatric patients.
在双极半髋关节置换术（BHA）中，保留软组织以降低术后脱位风险很重要。BHA有多种手术入路可供选择，但老年患者采用保留肌肉和肌腱的入路时需要格外小心。我们研究了在老年患者中使用联合保留肌腱后入路（CPP）进行BHA的有效性，该入路仅切开闭孔外肌。我们回顾性分析了40例年龄≥80岁、采用CPP入路行BHA的股骨颈骨折患者（10例男性，30例女性）的病例。患者平均年龄为85.8岁（80 - 94岁）。我们检查了手术时间、出血量、短外旋肌的保留情况、并发症以及术后X线片上的假体柄对线和下沉情况。虽然4例患者（10%）检测到下孖肌损伤，但所有病例的髋关节稳定性都非常好。没有术中骨折或术后脱位。在术后X线片上，所有股骨柄均处于中立位。40例患者均无假体柄下沉。采用CPP入路的BHA似乎即使在老年患者中也很有用。
