仰卧位常规器械OCM入路与后外侧入路全髋关节置换术的疗效对照

Comparison of total hip arthroplasty with conventional instrument OCM approach and posterolateral approach in supine position

目的:比较仰卧位常规器械OCM入路与后外侧入路全髋关节置换术的临床疗效。方法:2017年2月至2019年1月因髋关节疾病行髋关节置换患者67例,其中微创组21例采用OCM入路,男12例,女9例;股骨颈骨折10例,股骨头无菌性坏死5例,髋关节骨性关节炎6例。传统组46例采用传统后外侧入路,男28例,女18例;股骨颈骨折24例,股骨头无菌性坏死12例,髋关节骨性关节炎10例。所有患者使用生物型陶-陶人工关节假体。观察比较两组患者手术时间、术中出血量、切口长度、手术前后肌酸激酶(CK-NAC)、下地活动时间、住院时间、术后假体的外展角及前倾角。比较两组术前及术后12个月Harris评分。结果:所有病例获得随访,时间14~26(18.4±3.6)个月。两组患者术中出血、术后前倾角及外展角比较,差异均无统计学意义(P>0.05)。两组病例手术时间、切口长度、术后肌酸激酶、下地时间、住院时间差异均有统计学意义(P<0.05)。两组术前及术后12个月Harris功能评分差异均无统计学意义(P>0.05)。结论:两种入路人工全髋关节置换术均可获得满意的疗效,OCM入路损伤小,术后康复快,是可靠的手术入路。

Objective:To compare the clinical efficacy of total hip arthroplasty with conventional instrument OCM approach and posterolateral approach in supine position.Methods:From February 2017 to January 2019,67 patients underwent hip arthroplasty due to hip diseases,including 21 patients in the minimally invasive group,12 males and 9 females;there were 10 cases of femoral neck fracture,5 cases of aseptic necrosis of femoral head and 6 cases of hip osteoarthritis.In the traditional group,46 cases were treated by traditional posterolateral approach,including 28 males and 18 females;there were 24 cases of femoral neck fracture,12 cases of aseptic necrosis of femoral head and 10 cases of hip osteoarthritis.All patients used biological ceramic artificial joint prosthesis.The operation time,intraoperative bleeding,incision length,preoperative and postoperative creatine kinase(CK-NAC),underground activity time,hospital stay,abduction angle and anteversion angle of prosthesis were observed and compared between two groups.Harris scores before operation and 12 months after operation were compared between two groups.Results:All cases were followed up for 14 to 26(18.4±3.6)months.There was no significant difference in intraoperative bleeding,postoperative anteversion and abduction angle between two groups(P>0.05).There were significant differences in operation time,incision length,postoperative creatine kinase,underground time and hospital stay between two groups(P<0.05).There was no significant difference in Harris function score between two groups before operation and 12 months after operation(P>0.05).Conclusion:The two approaches of total hip arthroplasty can obtain satisfactory results.OCM approach has less damage and rapid postoperative recovery.It is a reliable surgical approach and can be popularized and used.