单切口双入路法在全髋关节置换翻修术中的应用

One-incision and two-approaches procedure of revision after hip arthroplasty

目的探讨单切口双入路手术技法在髋关节置换术后翻修的应用价值和初步临床疗效。方法有选择性地对2008年3月～2010年10月,17例全髋关节置换术后挛缩髋关节的患者采用单切口双入路全髋关节翻修手术。年龄56～83岁,平均66.7岁。记录手术时间和出血量,观察手术并发症的发生情况,术后采用Harris髋关节评分和MOMAC评分评估髋关节功能。结果手术时间120～210 min,平均130 min。术中出血量为300～560 mL,平均370 mL。该组患者均获得随访,随访时间8～27个月,平均14.2个月。术后及随访期间均未发生下肢深静脉血栓、坐骨神经或股神经麻痹、感染、关节假体松动或脱位等并发症。1例发生肺部感染,2例伤口延迟愈合。末次随访Harris评分由术前(22.8±5.6)分提高至(84.2±5.7)分,平均WOMAC评分由术前的56.2分降至术后的42.8分。结论单切口双入路手术技法为全髋关节置换术后挛缩髋的翻修手术提供一种值得选择的手术技巧,减少对血管神经损伤的风险,髋关节显露更充分和局部清创更彻底。

[ Objective ] Investigate the clinical application and outcome of revision after hip arthroplasty by one- incision and two-approach procedure （ITAP）. [Methods] From March 2008 to October 2010, 17 patients （17 hips） underwent total hip revision using ITAP performed, which included 7 males, 10 females, with the mean age of 66.7 years. Time of operating and loss of blood were recorded, the hip functions were evaluated with Harris score and WOMAC score systems, and the complications were observed. [Results] The time of operation were 120 to 210 min., the loss of blood were 300~560 mL. The patients were followed up for 8 to 27months. One patient developed pulmonary infection postoperatively who recovered well after symptomatic treatment, and two patients had delayed union of the incision. No deep vein thrombosis, sciatic nerve and femoral nerve palsies, infection, prosthesis dislocation or loosening were found. Harris scores improved from （22.8＋5.6） points preoperatively to （84.2±5.7） points postoperatively, and the mean WOMAC decreased from 56.2 preoperatively to 42.8 postoperatively. [Conclusion] ITAP is useful for revision after hip arthroplasty, and achieve excellent removal of contracture scar.