关键词: ">解剖仿生重建, 外旋肌群, 关节置换, 骨折, 梨状肌, 关节囊, 韧带修复, 生物力学

Abstract: BACKGROUND: The current focus of related research on surgical techniques for elderly hip fractures has shifted from mechanical structural repair to biomechanically precise reconstruction based on the principles of bionic medicine. Although the theory of anatomical reduction and repair is widely accepted, how to achieve an optimal balance between repair stability and joint range of motion through personalized treatment plans still requires further investigation.
OBJECTIVE: To investigate the application effect of anatomical bionic reconstruction of the external rotator muscles combined with repair of the zona orbicularis in unilateral artificial femoral head replacement.
METHODS: A retrospective cohort study was conducted, including 124 elderly patients with unilateral femoral neck fractures admitted to the Fifth Affiliated Hospital of Xinjiang Medical University from June 2021 to March 2023. All patients underwent  artificial femoral head replacement via a posterolateral approach. Based on comprehensive analysis of clinical data and preoperative doctor-patient communication, the patients were divided into two group: 65 patients underwent anatomical bionic reconstruction of the external rotator muscles combined with repair of the zona orbicularis (trial group), while 59 patients received conventional suture (fixing the joint capsule combined with the external rotator tendon to the greater trochanter, control group). Operative time, intraoperative blood loss, incision length, wound healing, hospital stay, complication rates, and readmission rates were recorded in the two groups. Postoperative visual analog scale scores, Harris scores, hip flexion-extension range of motion, and internal-external rotation range of motion were compared between the two groups to evaluate the clinical application value of the anatomical bionic reconstruction technique in unilateral artificial femoral head replacement.
RESULTS AND CONCLUSION: (1) No significant differences were found in the general data between the two groups (P > 0.05). (2) Perioperative indicators: one case in the trial group and two cases in the control group had grade B healing wounds, which healed well after active anti-infection treatment and regular dressing changes. The trial group showed significantly better intraoperative blood loss and incision length than the control group (P < 0.05). Operative time was longer in the trial group compared with the control group, but the difference was not statistically significant (P > 0.05). No significant differences were observed in wound healing or hospital stay between the two groups (P > 0.05). (3) There was no significant difference in the time to full weight-bearing activity between the two groups (P > 0.05). Compared with the control group, the trial group showed significantly better postoperative visual analog scale scores (except at 1 month postoperatively), Harris scores, hip flexion-extension range of motion, and internal-external rotation range of motion, indicating that superior long-term prognosis in the trial group was significantly better than that of the control group. (4) No significant difference was found in postoperative acetabular abduction angle between the two groups (P > 0.05). However, the trial group had a significantly higher postoperative anteversion angle than the control group (P < 0.05). (5) During regular follow-up, no prosthetic loosening, periprosthetic infection, or fractures were observed in either group. No dislocations occurred during hospitalization in either group. After discharge, one case in the trial group and three cases in the control group experienced dislocation, all of which were successfully reduced by manipulation under anesthesia. The difference was not statistically significant. (6) The results indicate that anatomical bionic reconstruction not only ensures joint stability but also achieves better functional outcomes, providing a new reference dimension for clinical surgical selection.

Key words: ">anatomical bionic reconstruction, external rotator muscles, joint replacement, fracture, piriformis muscle, joint capsule, ligament repair, biomechanics