内镜下微创前路全髋关节置换术早期疗效

Short-term efficacy of endoscope assisted arthroplasty for total hip replacement via a minimum invasive direct anterior approach

目的报告一种内镜下微创前路全髋关节置换术(Endo-THA)并回顾性分析其早期临床疗效。方法2019年11月至2020年5月福建省立医院骨二科对30例患者(32髋)行Endo-THA术,其中男12例13髋,女18例19髋,年龄32~87(63±14)岁,体质指数(BMI)(26.9±4.5)kg/m^(2)。通过平卧位直接前入路,用一个近端长5~6 cm的横向切口和一个远端1 cm的穿刺切口。在内镜完成髋臼侧磨锉与股骨侧松解,分体式打入髋臼假体。股骨侧通过顶钩法在横切口内完成准备与假体的安装。统计分析围手术期情况、手术时间、术后疼痛视觉模拟评分(VAS)、假体植入位置角度、关节功能改善情况、股外侧皮神经功能情况及患者自觉满意度。结果30例(32髋)手术切口长度(5.9±0.4)cm,所有患者切口均Ⅰ/甲级愈合。手术时间(65±14)min,术中出血量(136±56)ml,髋臼外展角41.4°±3.6°,髋臼前倾角16.0°±5.3°,术后6、24 h患者静息状态疼痛VAS评分均≤2分,活动锻炼后VAS评分与静息状态差异无统计学意义(均P>0.05),不同时间相同状态下VAS评分比较,差异亦无统计学意义(均P>0.05)。术后12 h内所有患者均可下地。术后住院1~3(2.0±0.9)d。术前患者髋关节Harris评分(35.5±8.1)分,术后6个月为(94.7±3.0)分,较术前显著改善(P<0.01)。无患者诉大腿前侧麻木,自觉满意度评分(9.3±0.5)分(满分10分)。结论Endo-THA术安全有效,避免了常规前路手术中拉钩对阔筋膜张肌的压迫,可应用于肥胖及肌肉健硕的患者。

Objective To present the surgical technique of endoscope assisted arthroplasty for total hip replacement via minimum invasive direct anterior approach and analyze its early clinical outcome.Methods From November 2019 to May 2020,endoscopic total hip arthroplasty via direct anterior approach was performed on 30 patients(32 hips),including 12 males(13 hips)and 18 females(19hips),in the Department of Orthopedics of Fujian Provincial Hospital.The average age of patients was(63±14)years(ranged 32-87 years).The average body mass index(BMI)of the patients was(26.9±4.5)kg/m2.There were 12 cases whose BMI was higher than 28.0 kg/m^(2) and the maximum BMI was 35.2 kg/m^(2).The surgery was performed on supine position using a 5-6 cm proximal transverse incision and a distal selective percutaneous puncture incision to perform the acetabulum preparation and the prosthesis implantation with the novel designed split tool under the monitoring of endoscope;the lift-top tractor system was used to raise the femur in the transverse incision for femoral side preparation and prosthesis implantation.Relevant data such as the perioperative status,operation time,postoperative pain score assessed with visual analogue score(VAS),prosthesis position,joint function,lateral femoral cutaneous nerve function and patient satisfaction were recorded to analyze the short-term efficacy.Results The average length of incision of the 30 cases(32 hips)was(5.9±0.4)cm.All patients in this study had I/A wound healing with no perioperative complications such as infection,poor wound healing and fractures of the proximal femur.The average operation time was(65±14)min,and the average amount of blood loss was(136±56)ml.The average acetabular abduction angle and acetabular antegrade inclinations was 41.4°±3.6°and 16.0°±5.3°,respectively.The resting-state VAS of pain at 6 h and 24 h after operation were all≤2,and there was no significant difference between the VAS scores after exercise and the VAS scores at the resting state(both P>0.05).There was no statistically significant difference between the VAS scores at the same state at different times(both>0.05).The weight-bearing exercise was applied in all patients within 12 h after surgery.The length of postoperative hospital stays varied from 1 to 3 days((2.0±0.9)days).At the 6th-month follow-up,the Harris score of the hip was 94.7±3.0,which significantly improved when compared with that before the operation(35.5±8.1)(P<0.01).No sensory abnormalities were observed.The satisfaction score of the patients was 9.3±0.5(full score set to 10).Conclusions The efficacy and safety of the endoscope assisted total hip arthroplasty for total hip replacement is acceptable.This procedure can help to reduce the compression of the muscles by the retractor in the conventional operation.It can be applied to obese and muscular patients.