前路经皮辅助关节囊上方入路全髋关节置换术应用探讨

Application of Total Hip Arthroplasty through Anterior Super PATH

目的探讨前路经皮辅助关节囊上方入路(Anterior SuperPATH)全髋关节置换术(THA)的手术技术和早期疗效。方法回顾性分析2019年11月至2020年10月在我院行THA的48例病人的临床资料,根据手术入路不同分为两组,23例采用前路经皮辅助关节囊上方入路者纳入Anterior SuperPATH组,25例采用经皮辅助通道上方关节囊入路者纳入SuperPATH组,记录并比较两组围手术期相关指标、髋臼杯位置、术后24 h疼痛视觉模拟量表(visual analogue scale,VAS)评分、术后6个月Harris评分、并发症发生情况。结果病人随访6~25个月,平均为12.3个月。两组手术时间、术中出血量、下床活动时间、术后24 h VAS评分、髋臼假体外展角、术后6个月Harris评分的差异无统计学意义(P>0.05)。Anterior SuperPATH组髋臼前倾角位置比SuperPATH组更佳,差异有统计学意义(P<0.05)。Anterior SuperPATH组大腿外侧麻木1例,SuperPATH组脱位1例、股骨大转子骨折2例。结论与SuperPATH组比较,Anterior SuperPATH组显示出相似的近期效果。前路经皮通道能够避免股骨的遮挡,直视化下操作,同轴髋臼侧处理,降低手术并发症,提高髋臼假体放置的精准性。

Objective To explore the surgical technique and early outcomes of total hip arthroplasty(THA)through Anterior Super PATH.Methods The clinical data of 48 patients treated with initial THA in our hospital from November 2019 to October 2020 were analyzed.These patients were divided into Anterior Super PATH group(23 cases)and Super PATH group(25 cases)according to different surgical approaches.The data were compared between two groups in term of peri-operative related indexes,acetabular cup position,visual analogue scale(VAS)score 24 h after operation,Harris score 6 months after operation and the incidence of complications.Results All of patients were followed up for 12.3(6-25)months.There were no significant differences in operation time,intraoperative blood loss,postoperative landing activity time,postoperative 24 h VAS,component abduction and Harris scores 6 months after operation between two groups(P>0.05).Anterior Super PATH was better than Super PATH for abduction angle of acetabulum(P<0.05).One patient had lateral thigh numbness in Anterior Super PATH group.One patient had dislocation,two greater trochanter fracture in Super PATH group.Conclusion Early experience with an Anterior Super PATH group demonstrates similar short-term outcomes compared with Super PATH group.The use of the anterior percutaneous technique can avoid femoral occlusion,has also allowed for concentric acetabular cup reaming and impaction under direct visualization,minimize complications and improve the placemeny accuracy of acetabular prosthesis.