两切口微创技术在全髋置换术中的应用

Two-Incision Minimal Invasive Approach for Total Hip Replacement

目的探讨两切口微创技术在全髋置换术中的临床应用价值。方法2003年12月至2004年6月间的30例行人工全髋关节置换手术者,随机分为两组:两切口微创全髋组15个、常规全髋置换组15个。比较两组在手术切口、手术时间、出血量、手术并发症、术后恢复与影像学等方面的差异。结果两切口微创全髋手术切口分别为3.6(3.0～4.5)cm、5.7(5.4～6.5)cm,常规手术组12.0(9.0～14.0)cm,P<0.05。两切口微创组与常规手术组的手术时间、出血量分别为:100(80～220)min、80(60～150)min,760mL、650mL,P<0.05,但所需输血量没有差异。两切口手术组与常规手术组比,具有手术后功能恢复快,住院时间短,双下肢不等长少,差异有显著性(P<0.05)。结论两切口人工全髋置换手术不切断髋关节周围肌肉,创伤小,具有术后恢复快,住院时间短的优点;但技术难度高,必须经过严格的培训才能开展,以防止并发症的发生。

Purpose Two-incision minimal invasive THR is a new surgical approach. The present study is to evaluate the safety and efficacy of two-incision minimal invasive surgery （MIS） in the total hip replacement. Methods From December 2003 to June 2004,30 hips in 30 patients were evenly randomized into two groups： 15 hips for two-incision minimal invasive, another 15 hips for routine THR. The incision length, operation time, blood loss, complications, rehabilitation and image studies were compared. The patients were followed up at least six months. Results Two incision lengths of minimal invasive surgery were 3.6 （3.0-4.5） cm and 5.7（5.4-6.5） cm, and the incision length of the routine THR was mean 12.0 （9. 0-- 14.0） cm, P〈 0.05. Mean operation time and mean blood loss of MIS vs standard operation were 100 （80- 220） minutes vs 80 （ 60-- 150） minutes and, 760 mL vs 650 mL （ P 〈 0.05 ）. However, the blood transfusion for the two groups were not statistically different. The two incision group showed rapid rehabilitation,short hospital stay and less leg discrepancy as compared to the routine group（ P 〈 0.05）. Conclusions Results suggest accelerated rehabilitation, decreased hospital stay and increased surgery duration for the two incision MIS group. However, the procedure is felt to be quite technically demanding and requiring an appropriate level of training,so that the complication should be avoided.