使用网片进行囊腔解剖重建以增强高脱位风险髋关节置换术的稳定性：一项随机对照试验。
Using mesh in capsule anatomical reconstruction to enhance the stability of high-dislocation-risk hip arthroplasty: a randomized controlled trial.
机构信息
Medical School of Chinese People's Liberation Army, Beijing, 100853, China.
Department of Orthopedics, The First Medical Center of Chinese PLA General Hospital, Fuxing Road, Haidian District, Beijing, 100048, China.
出版信息
J Orthop Surg Res. 2023 Feb 14;18(1):102. doi: 10.1186/s13018-023-03575-1.
BACKGROUND
Dislocation is a common complication after total hip arthroplasty (THA). This study aimed to compare the outcomes of mesh reconstruction versus conventional capsular repair in maintaining capsular integrity and preventing dislocation after THA.
METHODS
This was a prospective, randomized controlled study of consecutive patients. A total of 124 high-dislocation-risk THAs were identified and randomized into two groups, one using mesh reconstruction and the other using the conventional capsular repair method. Perioperative data and radiological data were collected. Patients were followed up regularly. The main indices were the capsular integrity assessed by magnetic resonance imaging (MRI) and hip dislocation rate. The secondary indices included the Harris hip score (HHS), complications, and satisfaction.
RESULTS
A total of 106 patients completed the follow-up and the average follow-up times were 19 ± 3.1 and 18 ± 3.3 months. The operation time of the mesh group was longer than that of the conventional group (P < 0.001). There were minor differences in acetabular anteversion and abduction angle, and the other data showed no differences. MRI results indicated that the success rate of capsular repair was higher in the mesh group (50 hips, 98%) than in the conventional group (37 hips, 67%) (P < 0.001), and the others failed the repair. Three dislocations occurred in the conventional group, while none occurred in the mesh group. The preoperative HHS (30 points) and postoperative HHS (82 points) of the mesh group were similar to those (35 points, 83 points) of the conventional group (P = 0.164, P = 0.328). Satisfaction had no difference (P = 0.532).
CONCLUSIONS
Compared to conventional repair, mesh reconstruction can effectively maintain capsular integrity and decrease dislocation risk after THA without increasing complications.
LEVEL OF EVIDENCE
Therapeutic study, Level IA.
背景
髋关节置换术后脱位是一种常见的并发症。本研究旨在比较网片重建与传统囊修复在维持髋关节置换术后囊完整性和预防脱位方面的效果。
方法
这是一项连续患者的前瞻性随机对照研究。共确定了 124 例高脱位风险的髋关节置换术，并随机分为两组，一组使用网片重建，另一组使用传统囊修复方法。收集围手术期数据和影像学数据。患者定期随访。主要指标是磁共振成像（MRI）评估的囊完整性和髋关节脱位率。次要指标包括髋关节Harris 评分（HHS）、并发症和满意度。
结果
共 106 例患者完成随访，平均随访时间为 19±3.1 和 18±3.3 个月。网片组的手术时间长于传统组（P<0.001）。髋臼前倾角和外展角有轻微差异，其他数据无差异。MRI 结果表明，网片组囊修复成功率（50 髋，98%）高于传统组（37 髋，67%）（P<0.001），其余均未修复。传统组发生 3 例脱位，网片组无脱位。网片组术前 HHS（30 分）和术后 HHS（82 分）与传统组（35 分，83 分）相似（P=0.164，P=0.328）。满意度无差异（P=0.532）。
结论
与传统修复相比，网片重建可有效维持髋关节置换术后囊完整性，降低脱位风险，且不增加并发症。
证据水平
治疗性研究，IA 级。
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