平卧位下改良前外侧入路人工全髋关节置换术的初步探讨

The preliminary study of modified anterolateral approach for total hip arthroplasty in supine position

目的探讨平卧位下改良前外侧入路全髋关节置换术的技术要点以及疗效。方法2013年8月-2016年8月采用平卧位下改良前外侧入路全髋关节置换术321例,男170例,女151例,年龄在46~84岁,平均76岁,记录切口长度、术中出血量、手术时间、术后下地时间、术后3月跛行率及Trendelenburg征阳性率、并发症,随访髋关节Harris评分。结果切口长度平均为8.4cm(7.0~10.0)cm,术中出血量平均165ml(110~300)ml,手术时间平均40 min(30~50)min,术后平均下地行走时间为2.5d(2~5 d),术后3个月跛行率及Trendelenburg征阳性率3%,未出现脱位、假体位置不良情况,随访时间最短3月,最长达3年,平均Harris评分达94.5分。结论平卧位下改良前外侧入路全髋关节置换术疗效确切,创伤小、恢复快、值得临床推广。

Objective To analyze the effect and the key technical points of modified anterolateral approach for total hip arthroplasty in supine position. Methods During August 2013 to August 2016, 321 cases（170 males and 151 females） underwent the modified anterolateral approach for total hip arthroplasty in supine position. The length of incision, intraoperative blood loss, operation time, postoperative ambulation time, claudication rate and trendelenburg positive rate 3 months postoperatively, and complications were recorded and Harris score was adopted for grading the function of the hip joint. Results The average length of incision was 8.4 cm （7.0~10.0） cm, the average amount of bleeding was 165 ml （110~300） ml, the average operation time was 40 min （30~50 min） , and the average postoperative ambulation time was 2.5 days （2~5 days）. 3 months postoperatively the claudication rate and trendelenburg syndrome with positive rate were 3%, and nobody had dislocation and defective prosthesis position; the follow-up period with a range of 3 months to 3 years revealed that the average Harris score was 94.5 points. Conclusion The modified anterolateral approach for total hip arthroplasty in supine position was a good surgical option with merits such as small trauma and quick recovery, suggesting thai is worth for clinical promotion.