SuperPATH入路微创全髋关节置换术67例观察

Supercapsular percutanously assisted total hip arthroplasty: a report of 67 cases

背景:微创全髋关节置换术一直以来都是骨科医师关注的热点,伴随着微创技术的不断进步,SuperPATH技术逐步进入了广大骨外科医师的视野。目的:探讨SuperPATH入路微创全髋关节置换术的优越性。方法:回顾性分析2016年4月至2017年9月采用SuperPATH入路行全髋关节置换术的67例(76髋)患者,手术均由同一组医生完成。记录手术时间、术中出血量、术中输血量、手术切口长度、手术前后血红蛋白差值、术后输血量、术后住院天数及并发症的发生情况,评估假体位置和髋臼外展角,采用VAS评分及髋关节HHS评分评定患者的髋关节功能。结果:术后6～23个月,平均(9.1±8.4)月。手术切口平均长度(7.6±0.7)cm。58例单侧THA平均手术时间为(122.9±35.4)min,术中平均出血量(468±258)ml,术中平均输血(268±230)ml,手术前后血红蛋白平均差值(28.7±11.5)g/L,术后平均输血(135±229)ml,术中透视(6±2)次。9例双侧THA平均手术时间为(262.2±32.9)min,术中平均出血量(917±571)ml,术中平均输血量(744±259)ml,手术前后血红蛋白平均差值(32.6±12.8)g/L;术后平均输血量(372±385)ml;术中透视(13±3)次。67例患者髋臼外展角平均46.7°±0.6°,前倾角17.8°±1.1°。术前HHS评分为(40.0±25.4)分;术后1周、1个月、3个月、6个月分别为(71.7±13.6)分、(84.1±6.5)分、(92.1±5.3)分、(94.2±4.2)分。术前VAS评分(8.0±1.4)分;术后1周、1个月、3个月、6个月分别为(2.2±1.0)分、(1.0±0.9)分、(0.5±0.7)分、(0.3±0.6)分。单侧THA患者术后住院天数平均(9±5)d,双侧THA患者平均(12±4)d。所有患者均无深静脉血栓形成、坐骨神经损伤麻痹等相关并发症。结论:SuperPATH微创全髋关节置换术具有手术切口短、对周围软组织损伤小、学习曲线短、术后早期功能锻炼、术后快速康复等优点。

Background： Minimally invasive total hip arthroplasty（THA） has always been a hot topic for orthopedics doctors.With the continuous development of minimally invasive technology, the clinical application of minimally invasive THA is increasing, especially the SuperPATH technology. Objective： To explore the superiority of SuperPATH approach. Methods： A total of 67 patients（76 hips） who underwent minimally invasive THA with SuperPATH approach from April 2016 to September2017 were analyzed retrospectively. The operations were performed by the same group of doctors. Operation time, intraoperative blood loss, intraoperative blood transfusion, incision length, hemoglobin changes, postoperative blood transfusion, postoperative hospital stay and complications, prosthesis position and acetabular abduction angle were recorded. VAS and HHS scores were used to evaluate the hip joint function. Results： All patients were followed up for an average of（9.1 ±8.4） months（range, 6-23 months）. The average incision length was（7.6 ±0.7） cm. The average operation time, intraoperative blood loss, intraoperative blood transfusion, hemoglobin difference before and after operation, postoperative blood transfusion, fluoroscopy in 58 patients undergoing unilateral THA were（123±35） min,（468±258） ml,（268±230） ml,（28.7±11.5） g/L,（135±229） ml and（6±2） times. The above-mentioned parameters in 9 patients with bilateral THA were（262.2±33.9） min,（917±571） ml,（744±259） ml,（32.6±12.8） g/L,（372±385） ml and（13±3） times. The mean abduction angle of the acetabulum was 46.7°±0.6°in the67 patients, and the acetabular anteversion was 17.8°±1.1°. HHS score was 40.0±25.4, 71.7±13.6, 84.1±6.5, 92.1±5.3 and94.2±4.2 preoperatively,1 week,1 month,3 months and 6 months postoperatively. VAS scores was 8.0±1.4, 2.2±1.0, 1.0±0.9,0.5±0.7 and 0.3±0.6 at each time point. The average postoperative hospital stay of unilateral and bilateral THA was（9±5） d and（12±4） d. No deep venous thrombosis or sciatic nerve paralysis was found. Conclusions： The SuperPATH approach has the advantages of short incision, slight damage to surrounding muscle tissue, short learning curve, early functional exercise after surgery and enhanced recovery after surgery.