全髋置换术配合术后系统治疗的近期疗效

Short-term outcomes of total hip arthroplasty in combination with postoperative systemic treatment

目的:比较全髋置换术配合术后系统治疗与不配合术后系统治疗的近期疗效。方法:2007年1月至2010年12月,将本科收治的46例人工全髋关节置换术(total hip arthroplasty,THA)患者随机分为实验组22例,对照组各24例。实验组采取多模式镇痛、术后皮下注射低分子肝素、当天开始渐进式系统功能训练,1周内患肢下地负重行走。对照组按传统方法术后1周开始床上运动,2周后下地行走训练。比较两组患者术后1、3月、半年、1年的患髋疼痛评分、临床功能、影像学评价、并发症发生情况。结果:两组患者均获得随访,观察组的平均住院时间(17.2±0.6)d、下床时间(5.8±1.7)d、并发症发生率4.6%±1.2%、VAS评分4.1±0.6均明显低于对照组,差异有统计学意义(P<0.05),Harris评分88.6±3.7高于对照组,差异有统计学意义(P<0.05)。结论:全髋置换术配合系统治疗,能减少并发症。

Objective：To compare short-term therapeutic outcomes of total hip arthroplasty （THA） alone or in combination with postoperative systemic treatment. Methods： A total of 46 patients treated with THA were enrolled between January 2007 and December 2010 in our department and were randomly allocated into experimental group （ n = 22） and control group （ n = 24）. Patients in experimental group underwent multimodal analgesia and received postoperative subcutaneous injection of low molecular heparin. In addition, progressive systemic functional training was performed since the initial day, and the operated limb was subjected to walk in a weight-beating manner at week 1. Patients in control group were ordered to move on bed at week 1, and received walking training after week 2, based on conventional approaches for managing postoperative conditions. Scales of hip joint arthralgia, clinical function, imaging assessment and complications were compared at postoperative months 1, 3 and 6 and year 1, respectively. Results： Patients of both groups were followed-up successfully. Experimental group presented shorter hospital stay [ （ 17.2 ± 0.6 ） days ] and time to getting off bed [ （ 5.8 ± 1.7 ） days]as well as lower occurrence of complications（4.6% ± 1.2% ） % and VAS score （4.1 ±0.6） with the exception of higher Harris＇ score （ 88.6 ± 3.7 ） as compared with that of control group （ all P 〈 0. 05 ）. Conclusion： Total hip arthroplasty in combination with postoperative systemic treatment is capable of reducing complications, promoting joint recovery and shortening hospital stay. Despite preferable short-term effectiveness, clinical outcomes on long-term basis remains to be further studied.