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[1]董玉鵬,季衛(wèi)鋒,尚美妍,等.支架輔助下直接前方入路微創(chuàng)全髖關(guān)節(jié)置換術(shù)治療發(fā)育性髖關(guān)節(jié)發(fā)育不良[J].中醫(yī)正骨,2018,30(10):30-35.
　DONG Yupeng,JI Weifeng,SHANG Meiyan,et al.Minimal invasive total hip arthroplasty through direct anterior approach assisted by supporting frame for treatment of developmental dysplasia of hip[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2018,30(10):30-35.
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支架輔助下直接前方入路微創(chuàng)全髖關(guān)節(jié)置換術(shù)治療發(fā)育性髖關(guān)節(jié)發(fā)育不良()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第30卷
期數(shù):
2018年10期
頁碼:
30-35
欄目:
臨床研究
出版日期:
2018-10-20

文章信息/Info

Title:
Minimal invasive total hip arthroplasty through direct anterior approach assisted by supporting frame for treatment of developmental dysplasia of hip
作者:
董玉鵬1; 季衛(wèi)鋒2; 尚美妍1; 曾森炎1; 張洋1; 沈景2
(1.浙江中醫(yī)藥大學(xué),浙江 杭州 310053; 2.浙江省中醫(yī)院,浙江 杭州 310006)
Author(s):
DONG Yupeng1; JI Weifeng2; SHANG Meiyan1; ZENG Senyan1; ZHANG Yang1; SHEN Jing2
1.Zhejiang University of Traditional Chinese Medicine,Hangzhou 310053,Zhejiang,China 2.Zhejiang Provincial Hospital of Traditional Chinese Medicine,Hangzhou 310006,Zhejiang,China
關(guān)鍵詞:
髖脫位; 先天性;  關(guān)節(jié)成形術(shù); 置換; 髖;  手術(shù)入路
Keywords:
hip dislocation; congenital;  arthroplasty; replacement; hip;  operative approach
摘要:
目的:比較支架輔助下直接前方入路(direct anterior approach,DAA)與傳統(tǒng)后側(cè)入路微創(chuàng)全髖關(guān)節(jié)置換術(shù)治療發(fā)育性髖關(guān)節(jié)發(fā)育不良(developmental dysplasia of hip,DDH)的臨床療效和安全性。方法:回顧性分析50例DDH患者的病例資料,其中采用支架輔助下DAA微創(chuàng)全髖關(guān)節(jié)置換術(shù)治療25例(DAA組),采用傳統(tǒng)后側(cè)入路微創(chuàng)全髖關(guān)節(jié)置換術(shù)治療25例(傳統(tǒng)后側(cè)入路組)。男26例,女24例。年齡39～77歲,中位數(shù)58歲。CroweⅠ型27例,CroweⅡ型23例。比較2組患者的手術(shù)時(shí)間、切口長(zhǎng)度、術(shù)中出血量、術(shù)后引流量、術(shù)后首次下地時(shí)間和術(shù)后住院時(shí)間,以及術(shù)前和術(shù)后1周、1個(gè)月、3個(gè)月、6個(gè)月、1年、2年時(shí)2組患者的Harris髖關(guān)節(jié)功能評(píng)分,觀察并發(fā)癥發(fā)生情況。結(jié)果:DAA組患者的切口長(zhǎng)度、術(shù)后住院時(shí)間和術(shù)后首次下地時(shí)間均短于傳統(tǒng)后側(cè)入路組[(8.54±1.41)cm,(13.24±2.45)cm,t=-8.298,P=0.000;(7.31±1.22)d,(14.83±3.42)d,t=-10.364,P=0.000;(12.14±3.52)h,(25.43±5.77)h,t=-9.832,P=0.000],術(shù)中出血量和術(shù)后引流量均小于傳統(tǒng)后側(cè)入路組[(242.17±32.64)mL,(361.38±53.28)mL,t=-9.542,P=0.000;(80.43±5.87)mL,(102.52±8.50)mL,t=-10.699,P=0.000]; 2組患者手術(shù)時(shí)間比較,差異無統(tǒng)計(jì)學(xué)意義[(69.30±4.45)min,(68.41±5.65)min,t=0.623,P=0.541]。Harris髖關(guān)節(jié)功能評(píng)分,時(shí)間因素和分組因素存在交互效應(yīng)(F=4.164,P=0.007); 2組患者Harris髖關(guān)節(jié)功能評(píng)分總體比較,組間差異有統(tǒng)計(jì)學(xué)意義,即存在分組效應(yīng)(F=9.327,P=0.048); 手術(shù)前后不同時(shí)間點(diǎn)之間Harris髖關(guān)節(jié)功能評(píng)分的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=31.356,P=0.000); 2組患者Harris髖關(guān)節(jié)功能評(píng)分隨時(shí)間均呈升高趨勢(shì),但2組的升高趨勢(shì)不完全一致[(41.41±2.43)分,(70.59±2.60)分,(78.23±3.37)分,(87.16±4.18)分,(92.52±4.76)分,(93.14±3.86)分,(93.21±4.71)分,F=17.631,P=0.000;(40.73±2.96)分,(62.87±4.28)分,(71.59±2.20)分,(82.87±6.33)分,(91.04±3.42)分,(92.47±4.64)分,(93.17±3.69)分,F=28.382,P=0.000]; 術(shù)前和術(shù)后6個(gè)月、1年、2年,2組患者Harris髖關(guān)節(jié)功能評(píng)分的組間差異均無統(tǒng)計(jì)學(xué)意義(t=0.888,P=0.379; t=1.263,P=0.213; t=0.555,P=0.581; t=0.033,P=0.973); 術(shù)后1周、1個(gè)月和3個(gè)月,DAA組患者Harris髖關(guān)節(jié)功能評(píng)分均高于傳統(tǒng)后側(cè)入路組(t=7.708,P=0.000; t=8.249,P=0.000; t=2.828,P=0.007)。2組患者均未出現(xiàn)并發(fā)癥。結(jié)論:與傳統(tǒng)后側(cè)入路微創(chuàng)全髖關(guān)節(jié)置換術(shù)相比,采用支架輔助下DAA微創(chuàng)全髖關(guān)節(jié)置換術(shù)治療DDH,創(chuàng)少小,住院時(shí)間短,能使患者盡早下床鍛煉,早期髖關(guān)節(jié)功能恢復(fù)快,可作為臨床治療DDH的一種較為理想的方法。但二者在手術(shù)時(shí)間和遠(yuǎn)期髖關(guān)節(jié)功能恢復(fù)方面無明顯差異。
Abstract:
Objective:To compare the clinical curative effects and safety of minimal invasive total hip arthroplasty(THA)through direct anterior approach(DAA)assisted by supporting frame versus conventional posterior approach(CPA)for treatment of developmental dysplasia of hip(DDH).Methods:The medical records of 50 patients with DDH were analyzed retrospectively.Twenty-five patients were treated with minimal invasive THA through DAA assisted by supporting frame(DAA group),while the others were treated with minimal invasive THA through CPA(CPA group).The patients consisted of 26 males and 24 females,and ranged in age from 39 to 77 years(Median=58 yrs).The DDH belonged to Crowe typeⅠ(27)and Ⅱ(23).The operative time,incision length,intraoperatve blood loss,postoperative drainage,bed rest time,postoperative hospital stay and Harris hip function scores before the surgery and at 1 week,1 month,3 months,6 months,1 year and 2 years after the surgery were compared between the 2 groups,and the complications were observed.Results:The incision length,postoperative hospital stay and bed rest time were shorter and the intraoperatve blood loss and postoperative drainage were less in DAA group compared to CPA group(8.54+/-1.41 vs 13.24+/-2.45 cm,t=-8.298,P=0.000; 7.31+/-1.22 vs 14.83+/-3.42 d,t=-10.364,P=0.000; 12.14+/-3.52 vs 25.43+/-5.77 hrs,t=-9.832,P=0.000; 242.17+/-32.64 vs 361.38+/-53.28 mL,t=-9.542,P=0.000; 80.43+/-5.87 vs 102.52+/-8.50 mL,t=-10.699,P=0.000).There was no statistical difference in operative time between the 2 groups(69.30+/-4.45 vs 68.41+/-5.65 min,t=0.623,P=0.541).There was interaction between time factor and group factor in Harris hip function scores(F=4.164,P=0.007).There was statistical difference in Harris hip function scores between the 2 groups in general,in other words,there was group effect(F=9.327,P=0.048).There was statistical difference in Harris hip function scores between different timepoints before and after the surgery,in other words,there was time effect(F=31.356,P=0.000).The Harris hip function scores presented a time-dependent increasing trend in the 2 groups,while the 2 groups were inconsistent with each other in the increasing trend of Harris hip function scores(41.41+/-2.43,70.59+/-2.60,78.23+/-3.37,87.16+/-4.18,92.52+/-4.76,93.14+/-3.86,93.21+/-4.71 points,F=17.631,P=0.000; 40.73+/-2.96,62.87+/-4.28,71.59+/-2.20,82.87+/-6.33,91.04+/-3.42,92.47+/-4.64,93.17+/-3.69 points,F=28.382,P=0.000).There was no statistical difference in Harris hip function scores between the 2 groups before the surgery and at 6 months,1 year and 2 years after the surgery(t=0.888,P=0.379; t=1.263,P=0.213; t=0.555,P=0.581; t=0.033,P=0.973).The Harris hip function scores were higher in DAA group compared to CPA group at 1 week,1 month and 3 months after the surgery(t=7.708,P=0.000; t=8.249,P=0.000; t=2.828,P=0.007).No complications were found in the 2 groups.Conclusion:Minimal invasive THA through DAA assisted by supporting frame has such advantages as less trauma,shorter hospital stay,shorter bed rest time and faster hip function recovery compared to minimal invasive THA through CPA in treatment of DDH,so it can be used as an ideal therapy for treatment of DDH in clinic.However,there is no obvious difference between the two therapies in operative time and long-term hip function recovery.

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備注/Memo

備注/Memo:
基金項(xiàng)目:中國博士后科學(xué)基金項(xiàng)目(2015M571246)
通訊作者:季衛(wèi)鋒 E-mail:[email protected]
更新日期/Last Update: 2019-02-25