后外侧入路小切口髋关节置换术的临床分析

Clinical analysis of posterolateral minimally invasive hip arthroplasty

目的探索后外侧入路小切口髋关节置换术与常规切口髋关节置换术的临床疗效差异。方法收集本院自2005-01—2015-09采用后外侧入路髋关节置换术治疗的646例(688髋)的临床资料,按照手术切口长度是否>10 cm分为小切口髋关节置换术组(A组)与常规切口髋关节置换术组(B组切口长度>10 cm),将A组分为2个亚组,分别为小切口全髋关节置换组(A1组切口长度≤10 cm)、小切口人工股骨头置换组(A2组),将B组分为2个亚组:常规切口全髋关节置换组(B1组)、常规切口人工股骨头置换术(B2组)。结果 A1组在切口长度(t=-47.153,P=0.002)、术中出血量(t=-2.537,P=0.014)、手术时间(t=-1.543,P=0.047)、输血量(t=-2.423,P=0.009)、住院时间(t=-1.744,P=0.041)方面均优于B1组,差异有统计学意义,2组术后引流量(t=-0.647,P=0.520)比较差异无统计学意义。A2组在切口长度(t=-20.427,P=0.013)、术中出血量(t=-1.849,P=0.021)、术后输血量(t=-2.253,P=0.003)方面均优于B2组,差异有统计学意义;2组术后引流量(t=0.239,P=0.810)和住院时间(t=-0.620,P=0.538)比较差异无统计学意义。2组术后相关功能均得到提升。结论小切口髋关节置换术在患者具有手术指征、实行相应术式的适应证、相同的基础条件的前提基础下,较之常规切口髋关节置换术,前者具有切口较小、手术时间较短、术中出血较少、术后输血较少、术后恢复较快等特点。在术者手术操作娴熟的前提下,若患者条件符合,小切口髋关节置换可以作为理想术式。

Objective To explore the difference in the clinical efficacy between posterolateral minimally invasive hip arthroplasty and conventional incision hip arthroplasty. Methods A total of 646 cases（688 hips） of hip arthroplasty described by department of orthopedics in first affiliated hospital of Hunan normal university from January 2005 to September 2015 were collected. These cases were divided into two groups according to the length of incision; the cases in which length of incision was less than or equal to 10cm were included in the posterolateral minimally invasive hip arthroplasty group（group A）, and the cases in which the length of incision was longer than 10 cm were in the conventional incision hip arthroplasty group（group B）. Group A was divided into 2 subgroups, the posterolateral minimally invasive total hip arthroplasty group （group A1） and the posterolateral minimally invasive artificial femoral head replacement group （group A2）. Group B was divided into 2 subgroup, conventional incision total hip arthroplasty group （group B1） and conventional incision artificial femoral head replacement group（group B2）. Results Between group A1 and group B1, in the average incision length（t =-47.153 ,P =0.002）, the average blood loss（t =-2.537, P =0.014）, the average operation time（t =-1.543, P =0.047）, the average blood transfusion（t =-2.423, P = 0.009）, and the average hospitalization time （t =-1.744,P =0.041）, the differences were statistically significant, but in the average drainage （t =-0.647, P =0.520） the difference was not statistically significant. Between group A2 and group B2, in the average incision length（t =-20.427, P =0.013）, the average blood loss（t =-1.849, P =0.021）, and the average blood transfusion （t =-2.253 ,P =0.003） the differences were not statistically significant, while in the average drainage （t =0.239 ,P =0.810） and the average hospitalization time （t =-0.620,P =0.538） the differences were not statistically significant. The follow-up showed that the prosthesis of the 2 groups was significantly improved. Conclusion With operation indications, indications of corresponding surgical methods, and the same basic conditions, posterolateral minimally invasive hip arthroptasty, compared with conventional incision hip arthroplasty, has the advantages such as smaller incision, less operation time, less blood loss, less blood transfusion, faster postoperative recovery, etc. With proficient operator, if patients＇ conditions are eligible, posterolateral minimally invasive hip arthroplasty can be regarded as ideal surgical method.