前外侧入路微创全髋置换的技术要点

Technical points of an anterolateral minimally invasive total hip replacement

背景:微创全髋关节置换的入路有前侧、前外侧、后外侧以及双切开入路等,但哪种入路更符合微创的概念且临床容易开展,目前尚无定论。目的:观察前外侧入路暨改良Watson-Jones入路微创全髋置换的临床应用效果。方法:选择2005-01/2006-12苏州大学附属第一医院骨科收治的施行前外侧入路微创全髋置换患者35例,男16例,女19例;年龄52～78岁,平均65.9岁;体质量指数19.3～30.1kg/m2,平均24.4kg/m2。观察切口长度、置换时间、置换过程及置换后输血量、并发症、置换后活动量、置换后住院天数、假体位置、置换后Harris评分等。结果与结论:35例患者均获得随访,随访时间6～24个月,平均17.3个月;置换切口长度7～10cm,平均8.3cm;置换时间70～120min,平均92.1min。输血量0～800mL,平均约300mL;患者术后即进行无负重下肢肌肉锻炼,术后第2天在医生指导下下床活动;住院时间6～15d,平均7.9d。置换后X射线平片测量髋臼外展角44°～53°,平均46.3°;大部分患者可扶拐走出病房。本组11例置换后3个月臀部疼痛,Harris评分为(79.5±4.4)分,置换后6个月9例臀部疼痛,Harris评分(84.0±3.6)分,置换后12个月5例,Harris评分(85.4±3.0)分,但所有病例均未出现持续的跛行和Trendelenburg征阳性。无感染、脱位或血管神经损伤等并发症出现。提示前外侧入路微创全髋置换创伤小,辅以适当的功能锻炼可获得较快的恢复。

BACKGROUND：There are a variety of surgical approaches for minimally invasive total hip replacement,such as anterolateral,posterolateral and two-incision.However,it is unknown which one is more in line with the concept of minimally invasive and easy to carry out.OBJECTIVE：To observe the clinical application effect of total hip replacement using anterlateral modified Watson-Jones approach.METHODS：From January 2005 to December 2006,35 patients were performed total hip replacement with the new anterlateral approach at the Department of Orthopaedics,the First Affiliated Hospital of Soochow University,including 16 males and 19 females,aged 52-78 years,mean aged 65.9 years;the average body mass index was 24.4 kg/m2（19.3-30.1 kg/m2）.The length of incision,operative duration,transfusion,complications,postoperative movement,postoperative hospital stay,prosthesis position and Harris score after operation were observed.RESULTS AND CONCLUSION：The patients were followed up 6-24 months,with an average of 17.3 months.The average length of incision was 8.3 cm（7-12 cm）.The mean operative duration was 92.1 minutes（70-120 minutes）.The average blood transfusion was 300 mL（0-800 mL）.All the patients were practice their limb muscles immediately after the operation and they were activity the day after operation under the guidance of doctor.The average postoperative hospital stay was 7.9 days（5-15 days）.Eleven hip pains occurred at 3 months,9 cases at 6 months and 5 cases at 12 months,the Harris scores were（79.5±4.4） points,（84.0±3.6） points,and（85.4±3.0） points,respectively.No infection,dislocation,vessel or nerve injury happened.From the follow up,all of the patients had good prosthesis position and rang of hip motion.The results revealed that the new anterolateral approach is minimally invasive total hip replacement,and the patients can recover faster via some proper exercise.