■囊切开术后最可靠的囊闭合缝合技术仍然未知。
■确定哪种缝合技术在5厘米的门间囊切开术后最好地恢复天然稳定性。
■对照实验室研究。
■使用6自由度机械臂在7种状态下对10个人类尸体髋关节标本进行了测试:完好无损,囊膜松弛,5厘米囊切开术,标准缝线,鞋带,双鞋带,和魁北克市滑块(QCS)。在9个测试中测量了旋转运动范围(ROM):屈曲,扩展,绑架,屈曲45°外展,内收,外部旋转,内部旋转,前部撞击,和日志卷。分心(即,股骨头平移[FHT])在屈曲和外展角度范围内进行测量。
■与本机状态相比时,在所有测试中,5厘米的囊切开术状态显示出最大的松弛度增加,特别是在外部旋转ROM(+13.4°),扩展ROM(+11.5°),和牵张FHT(+4.5mm)(所有P<.001)。在任何测试中,标准缝合技术与5厘米的囊切开术均无显着差异,并且显示出比双鞋带缝合线(1.41°;P=0.049)明显更大的屈曲ROM,比QCS更大的延伸ROM(5.51°;P=.014)和外部旋转ROM(6.03°;P=.021)。与鞋带缝线(+1.0mm;P=.005)相比,标准缝线也导致显著更高的牵张力FHT,双鞋带缝线(+1.4mm;P<.001),和QCS(+1.1mm;P=.003)。鞋带,双鞋带,与5厘米的囊切开术相比,QCS技术显着减少了髋关节松弛,特别是在外部旋转ROM(分别,-8.1°,-7.8°,and-10.2°),扩展ROM(-6.3°,-7.3°,and-8.1°),和牵张FHT(-1.8、-2.2和-1.9mm)(所有P≤.003)。这3种技术在一些但不是所有测试中恢复了天然稳定性(与完整没有显着差异),在任何测试中,它们之间没有观察到显著差异。
■采用标准缝合技术的髋关节囊闭合并不能防止5厘米的囊切开术后的髋关节不稳定,3种缝合技术被发现是优选的;然而,在时间零点没有完全恢复原生稳定性。
■鞋带,双鞋带,闭合髋囊时,建议采用QCS缝合技术。
UNASSIGNED: The most reliable suture technique for capsular closure after a capsulotomy remains unknown.
UNASSIGNED: To determine which suture technique best restores native stability after a 5-cm interportal capsulotomy.
UNASSIGNED: Controlled laboratory study.
UNASSIGNED: Ten human cadaveric hip specimens were tested using a 6-degrees-of-freedom robotic arm in 7 states: intact, capsular laxity, 5-cm capsulotomy, standard suture, shoelace, double shoelace, and Quebec City slider (QCS). Rotational range of motion (ROM) was measured across 9 tests: flexion, extension, abduction, abduction at 45° of flexion, adduction, external rotation, internal rotation, anterior impingement, and log roll. Distraction (ie, femoral head translation [FHT]) was measured across a range of flexion and abduction angles.
UNASSIGNED: When compared with the native state, the 5-cm capsulotomy state showed the largest laxity increases on all tests, specifically in external rotation ROM (+13.4°), extension ROM (+11.5°), and distraction FHT (+4.5 mm) (P < .001 for all). The standard suture technique was not significantly different from the 5-cm capsulotomy on any test and demonstrated significantly more flexion ROM than the double shoelace suture (+1.41°; P = .049) and more extension ROM (+5.51°; P = .014) and external rotation ROM (+6.03°; P = .021) than the QCS. The standard suture also resulted in significantly higher distraction FHT as compared with the shoelace suture (+1.0 mm; P = .005), double shoelace suture (+1.4 mm; P < .001), and QCS (+1.1 mm; P = .003). The shoelace, double shoelace, and QCS techniques significantly reduced hip laxity when compared with the 5-cm capsulotomy state, specifically in external rotation ROM (respectively, -8.1°, -7.8°, and -10.2°), extension ROM (-6.3°, -7.3°, and -8.1°), and distraction FHT (-1.8, -2.2, and -1.9 mm) (P ≤ .003 for all). These 3 techniques restored native stability (no significant difference from intact) on some but not all tests, and no significant differences were observed among them on any test.
UNASSIGNED: Hip capsule closure with the standard suture technique did not prevent postoperative hip instability after a 5-cm capsulotomy, and 3 suture techniques were found to be preferable; however, none perfectly restored native stability at time zero.
UNASSIGNED: The shoelace, double shoelace, and QCS suture techniques are recommended when closing the hip capsule.