Posterior transosseous capsulotendinous repair in total hip arthroplasty - A cadaver study
Posterior transosseous capsulotendinous repair in total hip arthroplasty - A cadaver study
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DOI：
10.2106/00004623-200210000-00009
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发表时间：
2002-10-01
影响因子：
5.3
通讯作者：
Van Audekercke, R
中科院分区：
文献类型：
--
作者：
Sioen, W;Simon, JP;Van Audekercke, R
背景：虽然最近的临床文章报道后路经骨修复后髋关节脱位率显着降低，但我们不知道任何已发表的生物力学数据支持这一发现。本研究的目的是探讨后路经骨修复的功能解剖结构及其对全髋关节置换术后稳定性的影响。方法：将六个全髋关节假体植入三具新鲜尸体中。然后在每个髋关节上连续测试三种不同的修复情况（无修复、软组织修复和经骨固定）。记录脱位时的扭矩阻力值和运动角度范围。每次修复测试两次，总共产生三十六个扭矩值和三十六个旋转角度。结果：经骨修复术在扭转强度（比未修复后强四倍[p = 0.0002]，比软组织修复后强两倍以上[p = 0.002]）和脱位前观察到的旋转角度大小（与未修复后相比增加83％[p = 0.0005]和与术后相比增加46％）方面均优于软组织修复 [p = 0.004]）。结论：在尸体模型中，后路经骨修复提供了全髋关节置换术的卓越稳定性。经过稍微修改的方法的最佳手术技术可以更好地保留关节囊和肌腱的长度，并更符合解剖学地重新插入软组织。
Background: While recent clinical articles have reported a dramatic reduction in rates of total hip dislocation after posterior transosseous repair, we are not aware of any published biomechanical data to support this finding. The objectives of this study were to investigate the functional anatomy of the posterior transosseous repair and its effect on stability after total hip replacement. Methods: Six total hip prostheses were implanted into three fresh cadavera. Three different repair situations (no repair, soft-tissue repair, and transosseous fixation) were then consecutively tested on each hip. Values for torque resistance and the angular range of motion at dislocation were recorded. Each repair was tested twice, yielding a total of thirty-six torque values and thirty-six angles of rotation. Results: The transosseous repair was superior with regard to both torsion strength (four times stronger than that after no repair [p = 0.0002] and more than twice as strong as that after soft-tissue repair [p = 0.002]) and the magnitude of the angle of rotation observed prior to dislocation (an increase of 83% in comparison with that after no repair [p = 0.0005] and an increase of 46% in comparison with that after soft-tissue repair [p = 0.004]). Conclusions: In a cadaver model, posterior transosseous repair provides superior stability of a total hip replacement. Optimal surgical technique with a slightly modified approach allows greater retention of capsule and tendon length and a more anatomical reinsertion of the soft tissues.