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[1]李文龍,范亞楠,張蕾蕾,等.微創(chuàng)全髖關(guān)節(jié)置換術(shù)直接前側(cè)入路 與外側(cè)小切口入路的對比研究[J].中醫(yī)正骨,2016,28(03):24-29.
　LI Wenlong,FAN Yanan,ZHANG Leilei,et al.A clinical comparison of direct anterior approach versus lateral small-incision approach in minimal invasive surgery total hip arthroplasty[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(03):24-29.
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微創(chuàng)全髖關(guān)節(jié)置換術(shù)直接前側(cè)入路 與外側(cè)小切口入路的對比研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第28卷
期數(shù):
2016年03期
頁碼:
24-29
欄目:
骨科微創(chuàng)技術(shù)
出版日期:
2016-03-20

文章信息/Info

Title:
A clinical comparison of direct anterior approach versus lateral small-incision approach in minimal invasive surgery total hip arthroplasty
作者:
李文龍1; 范亞楠1; 張蕾蕾1; 馬向浩1; 張穎2; 王會超 2; 劉又文2
1.河南中醫(yī)藥大學(xué),河南 鄭州 450008;
2.河南省洛陽正骨醫(yī)院/河南省骨科醫(yī)院,河南 洛陽 471002
Author(s):
LI Wenlong1; FAN Yanan1; ZHANG Leilei1; MA Xianghao1; ZHANG Ying2; WANG Huichao2; LIU Youwen2
1.Henan University of Chinese Medicine,Zhengzhou 450008,Henan,China 2.Luoyang Orthopedic-Traumatological Hospital,Luoyang 471002,Henan,China
關(guān)鍵詞:
關(guān)節(jié)成形術(shù); 置換; 髖;  手術(shù)入路;  外科手術(shù); 微創(chuàng)性;  治療; 臨床研究性
Keywords:
arthroplasty; replacement; hip;  operative approach;  surgical procedures; minimally invasive;  therapies; investigational
摘要:
目的:比較微創(chuàng)全髖關(guān)節(jié)置換術(shù)(minimal invasive surgery total hip arthroplasty,MIS-THA)直接前側(cè)入路與 外側(cè)小切口入路在手術(shù)創(chuàng)傷、臨床療效及安全性方面的差異。方法:選取71例接受單側(cè)MIS-THA手術(shù)的患者,33例采用直接 前側(cè)入路(前側(cè)入路組)、38例采用外側(cè)小切口入路(外側(cè)入路組)。記錄并比較2組患者的切口長度、手術(shù)時(shí)間、術(shù)中出血 量、輸血量、術(shù)后紅細(xì)胞沉降率(erythrocyte sedimentation rate,ESR)、術(shù)后C反應(yīng)蛋白(C-reactive protein,CRP)含 量、手術(shù)前后血紅蛋白差值、住院時(shí)間及并發(fā)癥發(fā)生情況。術(shù)后血紅蛋白含量、ESR、CRP含量在術(shù)后第2天測定。定期隨 訪,測定患側(cè)髖臼外展角和前傾角,并采用髖關(guān)節(jié)Harris評分量表評定髖關(guān)節(jié)功能。結(jié)果:與外側(cè)入路組相比,前側(cè)入路組 切口較小、手術(shù)時(shí)間長、術(shù)中出血少、輸血少、術(shù)后ESR低、CRP含量低、手術(shù)前后血紅蛋白差值小、住院時(shí)間短 [(7.24±0.61)cm,(9.74±0.92)cm,t=-13.852,P=0.000;(67.39±10.71)min,(61.84±5.33) min,t=2.702,P=0.010;(255.30±20.22)mL,(364.95±30.79)mL,t=-177.441,P=0.000;(1.85±1.20)單位, (3.47±1.29)單位,t=-5.467,P=0.000;(55.33±7.23)mm·h-1,(78.74±13.91)mm·h- 1,t=-9.058,P=0.000;(36.51±3.66)mg·L-1,(55.81±7.07)mg·L-1,t=- 14.712,P=0.000;(22.18±14.53)g·L-1,(30.76±15.22)g·L-1,t=-2.420,P=0.018; (9.22±1.01)d,(10.83±1.63)d,t=-5.062,P=0.000]。術(shù)后6個月2組患者的髖臼前傾角、髖臼外展角比較,組間 差異均無統(tǒng)計(jì)學(xué)意義(20.15°±5.32°,21.21°±3.66°,t=-0.963,P=0.340; 38.21°±4.28°,38.63°±3.12°,t=-0.466,P=0.643)。術(shù)前2組患者的Harris評分比較,差異無統(tǒng)計(jì)學(xué)意義 (t=1.190,P=0.238); 術(shù)后6個月2組患者的評分均增加[(39.12±11.47)分,(90.76±3.76)分,t=- 26.055,P=0.000;(42.21±10.41)分,(89.47±3.41)分,t=-27.015,P=0.000]; 2組患者手術(shù)前后Harris評分差值 比較,組間差異無統(tǒng)計(jì)學(xué)意義[(51.64±11.39)分,(47.26±10.79)分,t=1.661,P=0.101]。前側(cè)入路組1例發(fā)生股 外側(cè)皮神經(jīng)損傷、2例發(fā)生闊筋膜張肌損傷,外側(cè)入路組2例出現(xiàn)血腫、3例因術(shù)中拉鉤牽拉造成皮膚挫傷; 2組患者的并發(fā) 癥發(fā)生率比較,差異無統(tǒng)計(jì)學(xué)意義(P=0.716)。結(jié)論:采用直接前側(cè)入路和外側(cè)小切口入路行MIS-THA手術(shù),臨床療效和安全 性相當(dāng),均可有效改善患者髖關(guān)節(jié)功能,術(shù)后人工關(guān)節(jié)穩(wěn)定性好、并發(fā)癥少。但直接前側(cè)入路創(chuàng)傷較小,有利于患者術(shù)后康 復(fù)。
Abstract:
Objective:To compare direct anterior approach versus lateral small-incision approach in the operation wound,clinical curative effect and safety in minimal invasive surgery total hip arthroplasty (MIS-THA).Methods:Seventy-one patients were treated with unilateral MIS-THA,33 patients through direct anterior approach(anterior approach group),38 patients through lateral small-incision approach(lateral approach group).The incision length,operative time,blood loss,blood transfusions,postoperative erythrocyte sedimentation rate(ESR),postoperative C-reactive protein(CRP)contents,difference of hemoglobin between pre-operation and postoperation,hospital stay and complications were recorded and compared between the 2 groups.The postoperative CRP contents,ESR and CRP contents were measured at the 2nd day after the surgery.Regular follow-up was carried out for the patients.The acetabular abduction and anteversion angles of the affected side were measured,and the hip joint function were evaluated by using Harris hip scoring scale.Results:The anterior approach group had smaller incision,longer operation time,less blood loss,less blood transfusion,lower postoperative ESR and CRP contents,smaller difference of hemoglobin between pre-operation and postoperation and shorter hospital time compared to the lateral approach group (7.24+/-0.61 vs 9.74+/-0.92 cm,t=-13.852,P=0.000; 67.39+/-10.71 vs 61.84+/-5.33 min,t=2.702,P=0.010; 255.30+/-20.22 vs 364.95+/-30.79 ml,t=-177.441,P=0.000; 1.85+/-1.20 vs 3.47+/-1.29 units,t=- 5.467,P=0.000; 55.33+/-7.23 vs 78.74+/-13.91 mm/h,t=-9.058,P=0.000; 36.51+/-3.66 vs 55.81+/-7.07 mg/l,t=-14.712,P=0.000; 22.18+/-14.53 vs 30.76+/-15.22 g/l,t=-2.420,P=0.018; 9.22+/-1.01 vs 10.83+/-1.63 days,t=-5.062,P=0.000).There was no statistical difference in the acetabular front rake and acetabular angles of anteversion and abduction between the 2 groups at the 6 months after the surgery(20.15+/-5.32 vs 21.21+/-3.66 degrees,t=-0.963,P=0.340; 38.21+/-4.28 vs 38.63 +/-3.12 degrees,t=-0.466,P=0.643).There was no statistical difference in the Harris scores between the 2 groups before the surgery (t=1.190,P=0.238).The Harris scores increased in the 2 groups at the 6 months after the surgery(39.12+/- 11.47 vs 90.76+/-3.76 points,t=-26.055,P=0.000; 42.21+/-10.41 vs 89.47+/-3.41 points,t=- 27.015,P=0.000).There was no statistical difference between the 2 groups in the difference of Harris scores between pre-operation and postoperation(51.64+/-11.39 vs 47.26+/-10.79 points,t=1.661,P=0.101).The nervus cutaneus femoris lateralis injury(1 case)and tensor fasciae latae injury(2 cases)were found in the anterior approach group,while hematoncus(2 cases)and skin contusion(3 cases)caused by intraoperative traction with draw hook were found in the lateral approach.There was no statistical difference in the incidences of complications between the 2 groups(P=0.716).Conclusion:Direct anterior approach is similar to lateral small-incision approach in clinical curative effect and safety in the MIS-THA,and the MIS-THA through both of the two approachs can effectively improve hip joint function with good postoperative stability of joint prosthesis and few complications.However,the former has less injury,which is beneficial to postoperative recovery.

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通訊作者:劉又文 E-mail:[email protected]
更新日期/Last Update: 2016-03-30