小切口不保留关节囊的全髋关节置换术

Mini-incision total hip arthroplasty without reserving articular capsule

目的探讨小切口人工全髋关节置换术(THA)中不保留关节囊的安全性和实用价值。方法回顾性分析本组1999年1月至2009年1月行初次THA的患者,其中采用小切口不保留关节囊的THA(A组)141例163髋,男61例,女80例,年龄26～95岁,平均66.5岁;同期采用小切口不保留关节囊且未缝合修补外旋肌的THA(B组)88例101髋,男41例,女47例,年龄44～75岁,平均61.5岁;同期采用传统Gibson切口,保留关节囊的并修复外旋肌群的THA(C组)72例84髋,男30例,女42例;年龄33～80岁,平均68.3岁。对三组患者的手术切口长度、手术时间、出血量、髋脱位率、Harris评分进行比较。结果三组患者均获至少6个月的随访,A、B组在切口长度、手术时间方面与C组间的差异有统计学意义(P<0.05);三组之间出血量、髋脱位、术后6个月的Harris评分间的差异无统计学意义(P>0.05)。结论小切口THA具有微创一些优点,术中不保留关节囊,降低了手术难度,术野暴露充分,有利于髋臼假体及内衬的安装,并能有效缩短手术时间,不增加术后假体脱位率,从近期的疗效来看是一种安全快捷的髋关节置换方法。

Objective To evaluate security and practicability of mini-incision total hip arthroplasty （THA） without reserving articular capsule.Methods Primary THA cases from 1999-01 to 2009-01 were divided into three groups by retrospective analysis.141 patients （163 hips） were in Group A,including 61 men and 80 women from 26 to 95 years old with mean age of 66.5 years old.THA was performed with mini-incision,extortor repaire and unreserved capsule in this group.88 patients （101 hips） were in Group B including 41 men and 47 women from 44 to 75 years old with mean age of 61.5 years old.THA was performed with mini-incision and not repaired capsule and extortor in this group.72 patients （84 hips） were in Group C including 30 men and 42 women from 33 to 80 years old with mean age of 68.3 years old.THA was performed with traditional Gibson incision and repaired capsule and extortor in Group C.The comparative items among three groups included incisional length,operative time,operative bleeding,rate of dislocation after THA and Harris＇ score.Results All patients in three groups had been followed up for at least 6 months.There was significant difference in incisional length and operative time among group A,B and C.The incisional length and operative time were significantly different among group A,B and C.However there was no significant difference in the other parameters among three groups.Conclusions THA with mini-incision has some advantages of minimally invasive technique.The difficulty of this technique is degraded by resecting capsule.It is a safe and rapid method with limpid operating field to place the cup,shortened operative time and without increasing the risk of dislocation.