两种入路人工全髋关节置换治疗成人髋臼发育不良的近中期疗效对照

Total hip arthroplasty for developmental dyspiasia through OCM approach vs conventional approach:an early and mid term outcomes obervation

[目的]比较前外侧小切口（OCM）入路与前外侧入路人工全髋关节置换治疗成人髋臼发育不良的近中期临床疗效。[方法]回顾分析2001年6月-2011年6月在广西壮族自治区人民医院骨科进行单侧全髋关节置换的6l例成人髋臼发育不良伴骨性关节炎患者的临床资料。手术采用OCM和前外侧两种入路。对两组术口长度、术中出血量、手术时间、术后引流量、手术前后血红蛋白值、术后起床时间、术后住院时间、以及术前、术后、术后12个月及末次随访髋关节Harris评分及术后x线片影像进行评估比较。[结果]术后伤口均一期愈合，随访4～14年，平均（5．8±2．5）年。两组术中出血量、手术时间、术后引流量、手术前后血红蛋白值差异均无统计学意义（P〉0．05）；两组术口长度、术后起床时间、术后住院时间差异有统计学意义，OCM入路明显优于前外侧入路（P〈0．05）；两组术前、术后3、12个月及末次随访髋关髋关节功能Harris评分比较差异无统计学意义（P〉0．05）。[结论]两种入路人工全髋关节置换治疗成人髋臼发育不良中期疗效相当；OCM入路创伤小、患者术后恢复更快。

[ Objective] To observe and compare the early and mid term efficacies of two surgical approaches in total hip arthroplasty for the treatment of developmental dyspiasia of the hip. [ Methods] From June 2001 to June 2014, 61 cases of developmental dyspiasia of the hip combined with osteoarthritis were treated with the unilateral total hip arthroplasty. According to the surgical approach selection, patients were divided into OCM approach group （ n = 30 cases） and conventional anterior ap- proach group （ n = 31 cases） . The intraoperative bleeding volume, operation time, postoperative drainage volume, export length, the amount of hemoglobin before and after operation, as well as the postoperative get up time and hospital stay were re- corded. Harris score and X ray film were observed and assessed before surgery, immediately after surgery, at 12 month postoperatively and at the last follow up, respectively. [Results] The intraoperative bleeding, operation time, preoperative hemoglo- bin, postoperative drainage volume, postoperative hemoglobin were not significant different between two groups （ P 〉 0. 05 ）. Whereas the postoperative get up time and hospital stay in OCM group were lesser than in anterior group, with significant difference （ P 〈 0. 05 ） . At different follow up time points, the Harris score had no significant difference between two groups （ P 〉 0. 05） . [ Conclusion] Ahhrough two surgical approaches have the similar curative effectts for developmental dyspiasia of the hip, OCM approach has advantages of less trauma and faster postoperative recovery. It is a modified minimally invasive surgery method that has already been confirmed by early and mid term outcomes. Long -term follow- up is still need for investigation.