加速康复外科理念下SuperPATH入路与后外侧入路一期双侧全髋关节置换的比较

Comparison of one-stage bilateral total hip arthroplasty between SuperPATH approach and posterolateral approach based on enhanced recovery after surgery

背景:随着加速康复外科理念在骨科的不断推广和应用,关节外科医生对全髋关节置换术后疗效提出了更高的要求。传统后外侧入路的全髋置换创伤较大,术后恢复慢;微创入路全髋关节置换为骨科医师提供了新的选择。目的:比较微创Super PATH入路与常规后外侧入路在一期双侧全髋关节置换中的临床疗效。方法:回顾性分析苏州大学附属第一医院骨科自2016年4月至2018年4月行一期双侧全髋关节置换的患者25例(50髋),根据手术入路将患者分为2组,其中Super PATH组12例(24髋),后外侧入路组13例(26髋)。比较两组患者切口长度、手术时间、术中出血量、术后输血量、术前术后血红蛋白差值、住院天数;对比两组术后Harris评分(疼痛、功能、畸形、活动范围)、目测类比评分及并发症发生情况;比较两组术后臼杯外展角、前倾角和双下肢长度的差异。结果与结论:(1)所有患者围术期均进入加速康复外科管理流程,25例患者均顺利完成手术;(2)通过对比两组入路相关指标后发现,Super PATH组切口长度、术后输血量、术前术后血红蛋白差值均小于后外侧入路组,差异有显著性意义(P <0.05),但Super PATH组手术时间(255.17±38.57) min显著长于后外侧入路组(188.15±30.84) min(P <0.01);(3)Super PATH组患者术后第3,7天Harris评分显著高于后外侧入路组,差异有显著性意义(P <0.05);Super PATH组患者术后第1,3天目测类比评分低于后外侧入路组,差异有显著性意义(P <0.05);(4)两组患者术后髋臼假体的前倾角、外展角以及双下肢长度差异相比,差异均无显著性意义(P> 0.05);(5)结果表明,在加速康复外科理念指导下,一期双侧全髋关节置换中使用Super PATH微创入路是安全、有效的,与传统后外侧入路相比,该入路具有切口小、术后输血量和术后隐性失血量少、术后康复快、疼痛轻等优点。

BACKGROUND: With the gradual deepening of the concept of enhanced recovery after surgery, orthopedists have put forward higher requirements for the efficacy of total hip replacement. The traditional posterolateral surgical approach is traumatic, with slow postoperative recovery. Minimally invasive total hip replacement surgery provides a new option for orthopedic surgeons.OBJECTIVE: To compare the clinical effects of Supercapsular Percutaneously-Assisted Total Hip(Super PATH) approach and conventional posterolateral approach for one-stage bilateral total hip arthroplasty.METHODS: A retrospective study was conducted on 25 patients(50 hips) with one-stage bilateral total hip arthroplasty in the First Affiliated Hospital of Soochow University from April 2016 to April 2018. In terms of surgical approach conducted, 12 patients(24 hips) had total hip arthroplasty performed by Super PATH approach, while remaining 13 patients(26 hips) underwent total hip arthroplasty with posterolateral approach. The length of incision, operation time, intraoperative blood loss, postoperative blood transfusion, hemoglobin difference, and length of stay were compared between the two groups. Harris score(pain, function, deformity, range of motion), visual analogue scale score and complications were compared between the two groups after surgery. The differences in abduction angle, anteversion angle, and length of both lower limbs were compared between the two groups. RESULTS AND CONCLUSION:(1) All the patients entered in the enhanced recovery after surgery management process during the perioperative period. Totally 25 patients had operation performed smoothly.(2) Comparison of the related indexes of the two sets of approaches showed that Super PATH approach group had smaller surgical incision, less postoperative blood transfusion, and less hemoglobin difference compared with the posterolateral approach group(P < 0.05). However, operation time was longer in the Super PATH approach group(255.17±38.57) minutes than that in the posterolateral approach group(188.15±30.84) minutes(P < 0.01).(3) The Harris score of Super PATH approach group at 3 and 7 days after operation was significantly higher than that in the posterolateral approach group(P < 0.05). The visual analogue scale score at 1 and 3 days after operation was significantly lower in Super PATH approach group compared to the posterolateral approach group(P < 0.05).(4) There was no statistically significant difference in the length of lower limps, anteversion and abduction angle of the acetabular prosthesis(P > 0.05).(5) The results show that under the guidance of the concept of enhanced recovery after surgery, Super PATH minimally invasive in phase I bilateral total hip arthroplasty was safe and effective, with advantages of shorter incision length, less postoperative blood transfusion, less recessive blood loss, faster hip function recovery and less pain.