小切口在一期双侧全髋关节置换术中的应用

Application of Modified Mini-Incision for One-Stage Simultaneous Bilateral Total Hip Arthroplasty

目的探讨改良小切口在一期双侧全髋关节置换术中的临床应用。方法我院自2000年6月-2005年1月采用改良小切口技术进行一期双侧全髋关节置换术,临床应用17例34髋,切口长度为6.7-13.5 cm,平均(8.5±1.2)cm。分析其手术时间、总出血量、总输血量、术前与术后Harris评分及术周、术后并发症等。结果所有患者手术均在术前设计的切口下顺利进行,一侧开始手术至完成双侧手术时的总时间为(184.5±20.3)min,总出血量(1 258.4±246.5)ml,平均输血量(1 032.5±221.5)ml,Harris评分术前为39.2±12.5,术后为90.5±13.5(t=22.541,P<0.05)。术后并发脱位1例、精神症状1例;无肺栓塞、深静脉血栓形成、感染等发生。术后随访6.2-20.2月,X线检查示假体位置良好。结论在术前准备充分、解剖入路熟悉的前提下,采用改良小切口技术进行一期双侧全髋关节置换术可行,且具有创伤小、愈合快、瘢痕小、外形美观等优点。

Objective To evaluate the application of modified mini - incision for one - stage simultaneous bilateral total hip arthroplasty （ THA ）. Methods Seventeen patients （ 34 hips ） indicated for with bilateral THA had been perfonned one - stage simultaneous bilateral THA between June 2000 and January 2005. All hips were performed with total hip arthroplasty, and the mean length of incision was（8.5 ± 1.2）cm, from 6.7 to 13.5cm. These had been analyzed the operating duration, the total amount of blood loss, the amount of blood transfusion necessary, pre - operation functional scores of hips and post - operation functional scores, the perioperative and post- operative complications. Results The operations were performed successfully through modified mini - incision without disrupting soft tissue intra - operatively. The operating duration averaged （ 184.5±20.3 ） rain, the total amount of blood loss （ 1 258.4 ± 246.5 ） rnl, the amount of blood transfusion necessary （ 1 032.5 ± 221.5 ） rnl. and post - operation functional scores. The difference had statistical significance between post - operation functional scores of hips （90.5 ± 13.5）and pre- operation functional scores 39.2± 12.5（ P 〈 0.05） .The post- operative complications were happened to 2 cases, the dislocation of hips and mental symptoms, and no others complications in the series. Followed up period ranged from 6.2 to 20.2 months, and the position of the components were radiographic satisfactory. Conclusion With sufficient preoperative preparation and grasp of approaches, it is a excellent operative technique the modified mini - incision for one - stage simultaneous bilateral THA, possessing advantages through mini invasion, i. e. less trauma, rapid reeovery, small scar and beautiful outlook.