小切口人工全髋置换假体位置的准确性分析

Accuracy of components position in mini-incision surgery of total hip arthroplasty

[目的]评价小切口人工全髋关节置换术假体安放位置的准确性。[方法]自2005年9月～2006年3月行后外侧单切口入路小切口人工全髋关节置换术26例30髋和常规切口人工全髋关节置换术34例35髋。小切口组男15例,女11例,平均52±14.4岁,常规切口组男17例,女17例,平均48±11.7岁。比较两组手术时间、术中出血量、术后引流量、输血量、切口长度和并发症,分析术后影像学资料,测量髋臼杯外展角,髋臼杯前倾角,髋关节旋转中心,肢体长度,股骨假体内外翻比例。比较两组患者的临床疗效和假体安放位置的准确性。[结果]两组在年龄、性别、术后引流量、手术时间、体重质量指数无统计学差别。小切口组25例(29髋),常规切口组32例(33髋)随访18～24月(平均20.1个月)。小切口组术中出血量(497±64.9ml)比常规切口组(675±181.4ml)少(P<0.05)。常规切口组术后需要输血量明显增多(P<0.05)。两组患者无严重并发症发生。术后测量髋臼杯外展角小切口组37.7°±6.8°,常规切口组40.3°±5.8°;髋臼杯前倾角小切口组10.8°±7.2°,常规切口组13.2°±8.9°;髋关节旋转中心平均上移小切口组-1.4±2.5mm,常规切口组-1.5±3.8mm;术后肢体延长小切口组1.1±7.1mm,常规切口组1.5±8.4mm;股骨假体小切口组内翻1例,中置27例,外翻2例;常规切口组内翻2例,中置30例,外翻3例。两组假体位置相关参数测量数值差别无统计意义。[结论]在合理选择病例,术者具有丰富经验的情况下,小切口人工全髋关节置换术创伤小、出血少,与常规切口手术相比并不影响假体位置的安放。

[Objective]To evaluate the accuracy of the components position in mini-incision surgery （MIS） total hip arthroplasty （THA） by posterior-lateral single incision approach.[Method]From September 2005 to March 2006,26 patients （30 hips） were performed with MIS THA by posterior-lateral single incision approach, and 34 patients （35 hips） were performed with standard incision THA. The mean age of patients was 52±14.4 years ranging from 22 to 72 years in MIS group, and 48±11.7 years ranging from 30 to 65 years in standard group. Operation time,blood loss, length of incision, operation related complications,position of the components were analyzed.[Result]There were no significant differences in age, sex, BMI betweem the two groups. Twenty-five patients （MIS group） and 32 patients （standard group） were followed from 18 to 24 months （mean 20.1 months）. The operation time was similar in two groups. The blood loss in MIS group was 497±64.9ml and 675±181.4ml in standard group（P〈0.05）. No severe complication was found in the two groups. The obliquity angle of the cup was 37.7±6.8 degrees in MIS group and 40.3±5.8 degrees in standard group. Anteversion angle of the cup was 10.8±7.2 degrees in MIS group and 13.2±8.9 degrees in standard group. Rotation center of the hip was shift superiorly -1.4±2.5 mm in MIS group and -1.5±3.8 mm in standard group. After operation the leg was lengthened by 1.1±7.1mm in MIS group and 1.5±8.4mm in standard group. There was 1 case femoral stem inversion in MIS group and 2 cases in standard group, 2 cases eversion in MIS group and 3 cases in standard group, 27 and 30 cases that stem was in good position in the MIS group and standard group accordingly . There was no significant difference of the data in the two groups.[Conclusion]The advantages of MIS THA are less traumatic, less blood loss, no influence of the component position. But should be indicated in selected patients, used by experienced surgeon.