后路小切口全髋关节置换术疗效分析

The Analysis of the Outcomes of the Posterior Approach along the Femoral Neck Minimal Incision Total Hip Replacement

目的介绍一种小切口全髋置换术,即后侧经股骨颈入路全髋置换术,并对这种小切口与传统切口全髋置换术的短期疗效进行对比研究。方法选择连续60例需要行全髋人工关节置换术的病人为研究对象,随机分为两组,A组30例为后侧经股骨颈入路小切口全髋置换手术组,B组30例为传统后侧切口手术组。采集并对比的数据有：年龄、性别、手术髋（左/右）、体重、身高、体重指数、失血量、输血量、手术时间、切口长度、并发症、假体位置、使用助步器的时间、术前和术后的Harris髋评分结果。所有病人均采用全麻。术后对所有病人进行同样的抗凝治疗,鼓励病人积极主动地进行康复训练。随访时间6～24个月,平均13个月。计数资料采用χ2检验,计量资料采用t检验,P〈0.05为差异具有显著性。结果两组病例的体重指数、Harris髋分值、并发症发生率没有差异（P〉0.05）。A组病例较B组病例在切口长度、手术时间、失血量、住院时间、助步器使用时间方面有优势且差异显著（P〈0.05）。小切口手术组术后早期X线片显示假体匹配良好,位置佳,无脱位,无髋内外翻。髋臼假体外展角为43°～48°,平均45.5°;前倾角为16°～22°,平均17.7°。结论本研究的近期随访结果证实,与传统切口术式相比,后侧经股骨颈入路小切口全髋置换术具有以下优势：不增加术后并发症和假体位置不良的风险（P〉0.05）,降低失血量,缩短住院时间,快速恢复功能,但是小切口全髋置换术对术者的技术知识水平要求较高。

Objective Nowadays,the minimal incision total hip replacement（THR） has been considered to be one approach of the minimally invasive surgery. There are arguments about it in the orthopedics society. There are few domestic systematic compared studies about the minimal recision and the traditional THR. The objective of this study is to compare the short results between the minimal incision and the tradition THR. Methods 60 patients who need the THR are the objects of this study（30 with lateral minimal incision and 30 with standard incision）. The data which were collected are about：age, gender, hip （left/right ）, weight, height, body mass index, blood loss, blood transfusion, operation time,incision length,complication,prosthesis position ,time of use walking aids,the Harris hip score pre and after the operation. All the patients accepted the general anesthesia. Every patient received the same anticoagulant therapy post operation. All of them were encouraged to play an active role in the rehabilitation. The mean follow up time is 13 months（6 months to 24 months）. The numeration data were tested with chi square test. The measurement data are tested with t test,P〈0.05 means the difference is significant. Results There were no significant difference between the mini-incision group and the standard incision group about the body mass index,Harris hip score and complieation incidence （P〉 0. 05）. The minimal incision group was found to have a significantly advantages of incision length ,operation time ,blood loss ,length of hospital stay ,time of use walking aids （P〈0.05）. The prosthesis position indicated on the radiotelegram was quite well. There was no dislocation,coxa vara or valga,the mean abduction angle of acetabular cup was 45.5°（43°to 48°） ;the mean anteversion angle was 17.7°（16°to22°）. Conclusion The result of the early follow up of this study confirmed that the minimal incision THR didn＇t increase the risk incidence of the complications and the promise positions of the prosthesis compared with the standard THR（P〉0.05）. The minimal incision THR could reduce the blood loss and the hospital stay of the patients ,speed the rehabilitation to achieve function goal without increase the risk of the complications. But the surgeons who want to perform THR with this minimally invasive technique must be familiar with the regional anatomy and have already mastered the standard THR.