后外侧入路小切口人工全髋关节置换术

Preliminary experiences in mini-incision and minimally invasive surgery for total hip arthroplasty

目的探讨小切口人工全髋关节置换术(total hip arthrop lasty,THA)的适应证、技术要点及临床初步结果。方法2003年3月至2005年3月,采用改良后外侧入路的小切口人工全髋关节置换术治疗髋关节疾病患者43例49髋,男22例,女21例;年龄22￣79岁,平均53.2岁。体重指数17.1￣30.2,平均23.4。同期采用常规后外侧入路行人工全髋关节置换术35例43髋。两组年龄、性别及体重指数均衡(P>0.05),但疾病谱不同。对两组病例的围手术期出血量、手术时间、切口长度、术后早中期功能恢复情况及假体位置进行比较。结果小切口THA组31例(36髋)、常规THA组25例(31髋)随访6～24个月,平均13.1个月。小切口THA组切口长度平均9.3cm,较常规THA组短(P<0.05);围手术期出血量(318±223.1)ml,引流量(252±169.1)ml,均较常规THA组少(P<0.05);平均手术时间两组差异无统计学意义。小切口THA组术后早期功能恢复较常规THA组快,而中期结果相似。术后及随访时,两组假体位置均良好。小切口THA组无并发症,常规THA组1例术后脱位。结论小切口微创技术可选择性用于部分病例的人工全髋关节置换术,创伤小,围手术期出血少,切口小且不影响假体位置,术后早期功能恢复快。但应严格选择手术适应证,由拥有相应设备条件的医院及一定经验的医生开展。

Objective To explore the indication, to describe the key of operative technique in detail and to summarize the early results in mini-incision and minimally invasive surgery (MIS) total hip arthroplasty (THA) for hip disorders. Methods From Mar. 2003 to Mar. 2005, 43 patients (49 hips) were performed with MIS THA. The mean age of patients was 53.2 years ranging from 22 to 79 years. There were 22 males and 21 females. The average body mass index (BMI) was 23.4 ranging from 17.1 to 30.2. Using the modified postero-lateral approach, MIS THA was performed with cementless prostheses. For comparison, 35 patients (43 hips) were performed with standard THA at the same period. The age and BMI of patients in both groups were similar, but the pattern of disorders was different. The comparative items included preoperative bleeding, operative time, incisional length, postoperative functional recovery, and prosthetic position. Results 31 patients (MIS THA) and 25 patients (standard THA) were followed from 6 to 24 months (mean 13.1 months). No complications occurred in MIS THA. Dislocation appeared in one patient with standard THA at the two days after operation. The length of incision was 9.3 cm (range, 8.7 to 10.5 cm) in MIS group and 16.8 cm (range, 14 to 20 cm) in standard THA group. The difference was significant statistically (P< 0.05). Perioperative blood loss was (318±223.1) ml in MIS THA and (523±210.7) ml in standard THA respectively. The postoperative drainage was (252±169.1) ml and (507±217.7) ml respectively in two groups (P<0.05). The operation time was similar in two groups. The recovery of function was rapid in MIS THA at the early stage, but the functions of joint were similar in both groups six months after operation. The prosthetic position was good both in MIS and standard THA. Conclusion The MIS THA can be indicated in selected patients with hip disorders. The advantages of MIS THA are less trumatic, less blood loss, good cosmetic incision and rapid recovery of function. The MIS THA can only be used by surgeons rich in experience in THA and in hospitals provided with necessary instruments.