微创小切口和常规切口全髋关节置换术的疗效比较

Comparison of curative effect of minimally invasive incision and standard incision on total hip arthroplasty

目的比较微创小切口和常规切口全髋关节置换术的临床疗效。方法2004年6月至2008年6月,采用全髋关节置换术治疗98例患者。其中48例行单侧后路微创小切口全髋关节置换术,男26例,女22例;年龄45～85岁,平均66.8岁;股骨颈骨折19例,股骨头坏死19例,骨关节炎10例。另50例接受常规切口全髋关节置换术,男23例,女27例;年龄46～86岁,平均66.6岁;股骨颈骨折15例,股骨头坏死17例,骨关节炎8例,髋臼发育不良6例,类风湿关节炎4例。比较术中和术后各相关指标及并发症的发病率。结果全部获得随访,随访时间为6～15个月,平均8个月。微创组的手术切口长度、手术时间、术后2d C反应蛋白水平、术后2d红细胞沉降率、术后2d后大腿周径增加值均明显优于常规组,两组比较均有统计学差异(P<0.01)。两组的术中失血量、输血量、术后4周Harris评分均无统计学差异(P>0.05)。微创组的皮肤损伤8例,常规组19例,有统计学差异(P<0.01),两组的异位骨化、深静脉血栓、血肿等术后并发症均无统计学差异(P>0.05)。两组均无一例发生神经损伤、血管损伤、脱位及感染。结论微创小切口与常规切口全髋关节置换术比较,具有创伤小、手术时间短、感染概率低、人工关节稳定性强、患者恢复时间短等优势,手术切实可行。

Objective To compare the clinical effect of minimally invasive total hip arthroplasty through posterior skin incision with a standard incision operation.Methods From June 2004 to June 2009,48 patients underwent minimally invasive total hip arthroplasty through posterior skin incision under general anesthesia.Of them,there were 26 males and 22 females with an average age of 66.8 years（range,45-85 years）;femoral neck fracture in 19,femoral head necrosis in 19 and osteoarthritis in 10.And 50 patients were treated through standard incision.Of them,there were 23 males and 27 females with an average age of 66.6 years（range,46-86 years）;femoral neck fracture in 15,femoral head necrosis in 17,osteoarthritis in 8,dysplasia of hip in 6,and rheumatoid arthritis in 4.Intraoperative and postoperative data and complications were analyzed.Results All the patients were followed up and the average duration was 8 months （range,6-15 months）.There was no significant difference in intraoperative blood loss,blood transfusion,major com- plications,Harris hip score and postoperative complications（heterotopic ossification,deep vein thrombus,hematoma,et al）between 2 groups（P0.05）.But there was significant difference in the length of the skin incision,operation time, blood sedimentation and C-reaction protein（P0.01）.Skin destruction occurred in 8 patients with minimal incision and in 19 patients with conventional incision,which is statistically different（P0.01）.Conclusion Compared with conventional incision,minimally invasive incision for total hip arthroplasty can reduce the duration of operation and recovery, decrease the infection,and enhance the stability of artificial joint.