SuperPATH入路与后外侧入路行人工全髋关节置换术的疗效比较

Comparison of effectiveness between SuperPATH approach and posterolateral approach in total hip arthroplasty

目的通过与后外侧入路手术相比,探讨SuperPATH入路行人工全髋关节置换术(total hip arthroplasty,THA)的临床疗效。方法选择2016年1月—12月收治并符合选择标准的84例髋关节疾病患者纳入研究并随机分为两组,其中40例采用SuperPATH入路行THA(SuperPATH组),44例采用后外侧入路行THA(PSA组)。两组患者性别、年龄、体质量指数、疾病类型、合并基础疾病及术前下肢血栓形成、髋关节Harris评分等一般资料比较,差异均无统计学意义(P>0.05)。比较两组手术时间、术中失血量、切口长度、术后引流量、下地时间以及术后髋关节功能Harris评分、简明健康调查量表(SF-36量表)评分,X线片复查示假体位置。结果两组患者术后均获随访,随访时间6~18个月,平均10.3个月。SuperPATH组手术时间、术中失血量、切口长度、术后引流量及下地时间均优于PSA组(P<0.05)。SuperPATH组术后2周及1个月时Harris评分显著优于PSA组(P<0.05);术后3、6个月时两组比较差异无统计学意义(P>0.05)。末次随访时,SuperPATH组SF-36量表各项评分均高于PSA组(P<0.05)。术后X线片复查示假体位置良好。结论与后外侧入路相比,选择SuperPATH入路行THA具有创伤小、术后恢复快、手术安全性高的优势,能获得更好的临床疗效。

Objective To compare the effectiveness between SuperPATH approach and posterolateral approach in total hip arthroplasty（THA）. Methods Between January 2016 and December 2016, 84 patients with hip disease were included in the study and randomly divided into 2 groups. Forty patients were treated with THA via SuperPATH approach（SuperPATH group）, and 44 patients were treated with THA via posterolateral approach（PSA group）. There was no significant difference in gender, age, body mass index, the type of disease, the complicating diseases, and preoperative thrombosis of lower extremity and Harris score between 2 groups（P0.05）. The operation time, intraoperative blood loss, length of incision, postoperative drainage volume, unloaded activity time, Harris score, and shortform 36 health survey scale（SF-36） score were compared. The postoperative X-ray films were used to observe the position of joint prosthesis. Results All patients were followed up 6-18 months（mean, 10.3 months）. The operation time,intraoperative blood loss, length of incision, postoperative drainage volume, and unloaded activity time in SuperPATH group were significantly superior to those in PSA group（P0.05）. The Harris score at 2 weeks and 1 month after operation were significantly higher in SuperPATH group than that in PSA group（P0.05）. But there was no significant difference in the Harris scores at 3 and 6 months after operation between 2 groups（P0.05）. At last follow-up, the SF-36 scores were higher in SuperPATH group than those in PSA group（P0.05）. Postoperative X-ray films showed the joint prosthesis was in good position. Conclusion THA via SuperPATH approach has the advantages of minimal invasion, safe, and rapid recovery, which is better than THA via posterolateral approach.