小切口微创技术在全髋关节置换术中的应用

Mini-incision and minimal invasive technique used in total hip arthroplasty

目的阐述目前4种常用的微创全髋关节置换技术的应用体会，初步报道早期临床结果。方法自2003年8月至2005年11月采用4种常用的微创入路对92例116髋进行初次全髋关节置换术，男45髋，女71髋，年龄32-73岁，平均年龄64岁。手术方法采用前外路21例髋，后路73髋，双切口4髋，改良Watson-Jones微创入路（OCM）18髋。在92例中诊断为骨关节炎（OA）40髋；股骨头无菌坏死33髋；股骨颈骨折34髋；类风湿关节炎9髋。采用MIS工具和Versys假体。观察围手术期的出血量、手术时间、切口长度、术后功能康复情况及并发症。结果本组共92例，116髋，手术切口6-10cm，平均7cm；双切口微创全髋关节置换手术时间平均120min。而无论是采用单切口前路、后路或者改良Watson-Jones（OCM）手术入路平均手术时间90min。在92例患者中，其中10例行双侧全髋同时置换术中及术后平均输血400-600ml。而单侧全髋关节置换术的患者术中不输血，围手术期平均输血300ml。本组87髋随访6-24个月，平均随访13个月。术后半年随访87例，Harris评分87-92分，平均90.5分。术后1年随访52例，Harris评分90-96分，平均94分。结论4种微创全髋关节置换术均具有创伤小、出血少、术后功能恢复快的优点。OCM手术入路和双切口入路更符合微创全髋关节置换术的理念。

Objective To explore the technique about four kinds of the minimal invasive procedure for primary total hip arthroplasty and its early results. Methods from Aug. 2003 to Nov. 2005, 116 hips of 92 cases were given with 4 different MIS procedure in THA. The age of patients ranged from 32~73 years old. 21 hips with the lateral anterior single small incision, 73 hips with the posterior small incision, 4 hips with the two small incision, 18 hips with the anterior small incision or the modified Watson-Jones（OCM）small incision. In 92 cases, OA in 40 hips, AVN of femoral head in 33 hips, femoral neck fracture in 34 hips, RA in 9 hips. The instruments of MIS THA were provided by Zimmer company and the Versys prostheses were used in all hips. Results In 112 hips of 92 cases, the length of skin incision from 6~10 cm, average 7cm. The average operation time was 120min in two incision of MIS procedure, 90 min in other three kinds of single incision of MIS procedures. The amount of blood transfusion was from 400ml to 600ml in 10 cases of bilateral THA, and no transfusion during operation, average 300ml of transfusion after operation in single hip THA. 87 hips were followed up from 6 months to 24 months and average 13 months. 6 months of posterior operation, the Harris score was 87~92, average 90.5. 52 cases were followed up 16 months and the Harris score was 90~96, average 94. Conclusion There are advantages of less trauma, less blood loss, more quick recovery of hip function in all the four procedures of MIS THA. The anterior approach or OCM procedures and two incisions approach are more correspond with modern philosophy of minimal invasive procedure. The OCM procedures was more simple and more easy to learn.