前路小切口人工全髋关节置换术疗效分析

Minimally invasive total hip arthroplasty with anterior incision

目的对前路小切口人工髋关节置换术(THA)的临床效果进行回顾分析。方法将2002年8月至2004年2月施行THA的120例患者随机分成两组,每组60例患者,分别采用前路小切口和传统后路切口,对手术时间、出血量、并发症、切口长度、术后平均住院时间、术后Harris评分进行比较。结果平均随访20个月(12～30个月)。小切口组的平均手术时间为72min,传统切口组为69min(P>0.05);小切口组的平均切口长度为7.9cm,传统切口组为16.3cm(P<0.01);小切口组出血量平均为350ml,传统切口组650ml(P<0.01);小切口组平均术后住院时间为7d,传统切口组为13.5d(P<0.05)。小切口组术后X线片髋臼前倾角平均为24°,传统切口组为19°;小切口组外展角平均为47°,传统切口组为45°。术后3个月随访时,小切口组的平均Harris评分为91.4分,传统切口组为78.5分(P<0.05);末次随访时,小切口组的平均Harris评分为95.1分,传统切口组为95.6分(P>0.05),但两组髋关节活动度差异有统计学意义,分别为(110.0±3.2)°和(90.0±2.9)°(P<0.05)。两组患者都未出现感染、血管神经损伤等并发症。小切口组有1例术中摄片发现髋臼前倾角偏大,立即将髋臼取出重新安放,术后无不良反应。传统切口组2例症状性DVT,1例出现嗜睡,CT示脑基底节小梗塞灶。结论前路小切口THA具有创伤小、出血少、美观的优点,是一种安全、有效、可靠的方法。

Objective To report the clinical outcome of minimally invasive total hip arthroplasty with anterior incision. Methods One hundred and twenty cases were randomly divided into two groups, Sixty cases （ group 1 ） who had undergone a mini -invasive THA were compared with 60 cases （ group 2） who had undergone THA with standard posterolateral incision. The operation time, length of incision, blood loss, anteversion angle of acetabulum cup, Harris score and complications were observed. Result The average operation time was almost the same; The average length of incision for group 1 was 7.9 cm （7, 4-9.0 cm） and 16. 3 cm （ 14-22 cm） for group 2 （P 〈0. 01 ）. The average blood loss for group 1 was 350 ml（250-530 ml） and 650 ml（400-1200 ml） for group 2, there was significant difference between two groups（P 〈0. 05） According to the postoperative X-ray, the mean anteversion angles of cup were 24°（ 19°-27°） for group 1 and 19°（15°-22°） for group 2. The average length of post-operative hospital stay was 7days （5-8 days） in group 1 and 13.5 days （12-16 days） in group 2 （P〈0.05）. The Harris score of group 1 was 91.4（67 ～94） and 78.5 （67～ 91 ） for group 2 at the 3 month follow-up （P 〈 0. 05）. At the last follow up, there were no significant difference （P 〉 0. 05 ）, but the average ROM of group 1 were definitely more greater than that of group 2 （110.0° ±3.2°vs. 90.0° ±2.9°P 〈 0.05）.There was 1 case of cup reinsertion in group 1 because of large anteversion angle; 2 cases of symptomatic DVT and 1 case of lethargy because of cerebral infarction happened in group 2. Conclusions Minimally invasive total hip arthroplasty using anterior approach is a safe and effective technique with the advantages of less soft tissue damage and less blood loss.