微创小切口人工全髋关节置换术在晚期股骨头坏死治疗中的应用

PRELIMINARY EXPERIENCES IN MINIMALLY INVASIVE AND MINI-INCISION SURGERY TOTAL HIP ARTHROPLASTY FOR LATE OSTEONECROSIS OF THE FEMORAL HEAD

目的探讨微创小切口人工全髋关节置换术在晚期股骨头坏死治疗中的应用价值. 方法 2003年3月始,采用微创技术治疗18例22髋国际骨循环学会(Association Research Circulation Osseous, ARCO)分期Ⅲ、Ⅳ期股骨头坏死患者,其中男13例,女5例,年龄24～57岁;体重指数(body mass index,BMI)24.6(17.1～30.1),术前髋关节Harris评分平均46分.均采用改良的后外侧切口、非骨水泥假体行人工全髋关节置换术(微创组).与同期常规人工全髋置换术的18例22髋(对照组,术前髋关节Harris评分平均43分)进行比较,包括:围手术期出血量、切口长度及术后早期功能恢复情况等. 结果术后两组均获随访6～20个月,平均11个月.对照组1髋术后2 d脱位,微创组中无并发症发生;微创组手术切口长9.3 cm(8.7～10.5 cm),较对照组16.8 cm(14.0～20.0 cm)短,差异有统计学意义(P<0.01);两组术后随访6个月时Harris评分分别为92、90分,差异无统计学意义(P＞0.05);手术时间相近,但围手术期出血量及引流量微创组较少,两组差异有统计学意义(P＜0.05);微创组术后恢复较快. 结论微创小切口全髋关节置换术,手术创伤小、出血少,术后恢复较快,但开展此手术的初期,应由有经验的医师及有相应设备的医院、有选择地用于晚期股骨头坏死患者的治疗.

Objective To explore the effect of minimally invasive and mini-incision surgery （MIS） in total hip arthroplasty （THA） on late osteonecrosis of femoral head （ONFH）. Methods From March 2003, Eighteen patients （22 hips） with ONFH underwent MIS in THA. Their ages ranged from 24 to 57 years, including 13 males and 5 females. The mean body mass index ranged from 17.1 to 30.1（24.6 on average）. The Harris hip score was 46 points before operation. Modified posterior lateral approach was adopted, and the MIS THA was performed by cementless prosthesis. Asa comparison, 18 patients （22 hips） were performed by conventional THAat the same period, The data, including bleeding volume during operation, incision length, operative time, and postoperative function recovery, were compared. Results Follow ups were done for 6 to 20 months （11 months on average）. Dislocation occurred in one patient that underwent conventional THA 2 days after operation. No complication occurred in MIS THA group. The incision lengths ranged from 8.7 to 10.5 cm （9.3 cm on average） in MIS THA group, being statistically different （P〈 0. 0l）. There was no significant difference in Harris scoring of the function between the two groups both before the operation and after the operation （P〉0.05）. The operative time was almost the same, but the bleeding volume in MIS THA group was less （P〈0.05）. The function recovery was faster in MIS THAgroup. Conclusion The MIS THA is an alternative to the treatment of late ONFH. The advantages of MIS THA are fewer trauma, less bleeding volume, and faster recovery. The MIS THA should be performed by surgeons with rich experiences in THA and hospitals with necessary instruments.