全髋关节置换术小切口与传统切口临床比较研究

Total hip arthroplasty:a comparison between mini-incision approach and conventional incision approach

目的比较后外侧小切口全髋关节置换术(THA)与传统THA的临床疗效及并发症。方法 2004年11月至2009年6月,对38例(40髋)患者行后外侧小切口(6～10cm)THA,47例(48髋)患者行传统切口(11～15cm)THA。所有病例均由同一位主刀医生完成手术。结果术后随访平均21.2个月(18～24个月),两组病例均未出现感染、假体脱位及神经损伤等并发症,小切口THA组有2例患者术中发生切口近端皮肤擦伤,传统THA组有1例患者术后发生深静脉血栓。小切口THA组和传统THA组手术时间分别为72(60～100)min和69(70～175)min,术中出血量分别为350(250～520)ml和393(270～600)ml,差异均无统计学意义(P>0.05);手术切口分别为9.2(6.8～10)cm和16.4(14～24)cm,术后12h引流量分别为211(120～300)ml和249(140～400)ml,平均住院时间分别为6.6d和7.5d,差异均有统计学意义(P<0.05);术后第1、2、3天疼痛视觉模拟评分(VAS)分别为4.0分、3.1分、2.3分和4.6分、3.7分、2.4分,术后1、3个月Harris评分分别为90.5分、91.1分和88.2分、91.2分。术后影像学表现无统计学差异。结论后外侧小切口THA在适宜手术适应证前提下与传统THA相比,具有减少软组织损伤、缩短住院时间、减轻术后疼痛和加快术后康复的优势。

Objective To study the efficacy and complications of mini-incision total hip arthroplasty （THA） compared with conventional approach THA. Methods From November 2004 to June 2009, 38 patients （40 hips） received THA using the modified posterolateral mini-incision approach （6 10 cm） and 47 patients （48 hips） received THA using conventional approach （1 115 cm）. All the surgery were performed by the same surgeon. Results The mean duration of follow up was 21.2 months （range, 18-24）. No infection, prosthetic dislocation or nerve injury was occurred in either group. Two cases had superficial wound scratches in mini-incision group, and in conventional group one patient had deep venous thrombosis. The mean operation time of mini-incision group and conventional group was 72 minutes （range, 60-100） vs 69 minutes （range, 70-175）, and blood loss averaged 350 ml （range, 250 520） vs 393 ml （range, 270 600）, there was no statistical difference （P〉0. 05）. The mean length of skin incision of mini-incision group and conventional group was 9. 2 cm （range, 6.8-10） vs 16. 4 cm （range, 14-24）, and the mean postoperative 12-hour drainage flow was 211 ml （range,120-300） vs 249 rnl （range, 140-400）, and hospitalization time was mean 6.6 days vs 7.5 days. The differences between groups were statistically significant （P〈0. 05）. The visual analogue scale （VAS） of the first three days after surgery were 4. 0, 3. 1 and 2. 3 in mini-incision group vs 4. 6, 3.7 and 2. 4 in conventional group. The mean Harris hip score after 1 and 3 months was 90.5 and 91.1 in mini-incision group vs 88. 2 and 91.2 in conventional group. There was no difference in functional or radiographic results. Conclusion The posterolateral mini-incision approach THA can minimize surgical trauma to the soft tissues, shorten hospitalization time, reduce postoperative pain and improve rehabilitation compared with the conventional approach THA in appropriate indication.