改良Hardinge入路在人工全髋关节置换术中的应用研究

Application Study of Modified Hardinge Approach in Total Hip Arthroplasty

目的探讨改良Hardinge入路行人工全髋关节置换术(total hip arthroplasty,THA)的临床疗效及安全性。方法回顾性分析作者医院骨科2013-01/2016-01月采用改良Hardinge入路行THA且获得至少1年以上随访的182例患者。记录所有患者的术中出血量、髋臼杯前倾角、髋臼外展角、手术时间、手术切口长度、并发症发生率、术后住院时间、术后复查X光片情况以及术前与术后1年髋关节Harris评分并作统计学分析。结果共182例患者(200髋)符合本项研究的要求,所有患者随访1~3(2.1±0.5)年。术中出血量100~400(210±57.2)ml;髋臼杯前倾角10~20(14.6±0.6)°;髋臼外展角38~48(46.3±0.7)°;手术时间68~167(93±12.5)min;切口长度10~15(11.5±1.3)cm。术后并发症出现4例(2%),分别是1例假体脱位,2例神经牵拉损伤,1例感染。术后住院7~21(10.7±3.7)d;术前Harris评分为12~56(31.8±3.3)分、术后1年随访Harris评分75~95(87.1±5.7)分,优良率达90.8%。术前及术后1年髋关节Harris评分比较有统计学差异(P<0.01)。所有患者术后复查X光片均显示假体大小、位置合适。结论改良Hardinge入路行人工THA显露良好,微创安全,术后关节稳定性好,疗效确切。

Objective To investigate clinical efficacy and safety of modified Hardinge approach in total hip arthroplasty（THA）.Methods A retrospective study of 182 patients who had taken modified Hardinge approach for THA and followed-up at least 1 year in authors＇ hospital from January 2013 to January 2016 were analyzed.The intraoperative blood loss,acetabular anteversion,acetabular abduction,operation time,incision length,complication rate,postoperative hospital stay,preoperative and postoperative Harris hip scores and postoperative X ray results were recorded and analyzed.Results A total of 182 patients（200 hips）were in accordance with the study criteria.The intraoperative blood loss was 100-400（210±57.2）ml,acetabular anteversion was 10-20（14.6±0.6）°,acetabular abduction was 38-48（46.3±0.7）°,the operation time was 68-167（93±12.5）min,average length of incision was 10-15（11.5±1.3）cm.Four cases（2%）had postoperative complications,including 1 case of prosthesis dislocation,2 cases of nerve injury,1 case of infection.Postoperative hospital stay was 7-21（10.7±3.7）days,preoperative Harris score was 12-56（31.8±3.3）scores,the follow-up Harris score after 1 year was 75-95（87.1±5.7）points,the excellent and good rate was 90.8%.There was a significant difference between preoperative and postoperative Harris hip scores（P〈0.01）.Postoperative X ray of all patients showed that the size and the position of prosthesis was good.Conclusion The modified Hardinge approach for THA is well exposed,with minimally invasive.The postoperative joint stability is good,and the curative effect is accurate.