“一次磨臼技术”在髋关节置换手术中的应用研究

Application of "One-time Grinding Technique" in Hip Arthroplasty

目的:探讨“一次磨臼技术”在髋关节置换手术中的应用效果,为改善这类患者预后提供新思路及依据。方法:选取肇庆市第一人民医院2019年1月-2022年4月收治的70例全髋关节置换患者,随机分为观察组与对照组,各35例。观察组采取“一次磨臼技术”策略,直接用术前影像学资料测定的最大号直径磨钻,研磨髋臼至软骨完全去除。对照组采取常规策略,用髋臼锉从最小42号开始逐号换大号(传统42、44、46、48号……)打磨,直至软骨下骨均匀渗血。之后两组均安装股骨假体柄及股骨头假体,复位髋关节。记录两组的手术时间、术中及术后24 h出血量、髋臼假体外展角、前倾角、髋臼杯位于安全区域比率、Harris髋关节功能评分及并发症发生情况。结果:观察组的手术时间短于对照组,术中及术后24 h出血量均少于对照组,差异均有统计学意义(P<0.05)。术后1周,观察组Harris髋关节功能评分高于对照组,且患肢缩短长度小于对照组(P<0.05)。两组的平均髋臼假体外展角、前倾角均在正常安全范围内,术后1周,观察组外展角大于对照组,前倾角小于对照组,差异有统计学意义(P<0.05)。两组并发症发生率比较,差异无统计学意义(P>0.05)。结论:对髋关节置换手术患者采取“一次磨臼技术”不仅有助于缩短手术时间,减少术中出血量,还能够有效改善患者髋关节功能,且不会增加并发症的发生风险,具有较好的安全性,值得临床推广应用。

Objective: To explore the application effect of "one-time grinding technique" in hip replacement surgery, and to provide new ideas and basis for improving the prognosis of such patients. Method: A total of 70 patients with total hip replacement admitted to Zhaoqing First People’s Hospital from January 2019 to April 2022 were selected, and randomly divided into observation group and control group, with 35 cases in each group. The observation group adopted the strategy of "one-time grinding technique" and directly used the largest diameter grinding drill measured by preoperative imaging data to grind the acetabulum until the cartilage was completely removed. The control group adopted the conventional strategy, and the acetabular file was changed from the smallest 42 to the larger one(traditional 42, 44, 46, 48...) until the subchondral bone oozed blood evenly. After that, the femoral stem and femoral head prosthesis were installed in both groups to reduce the hip joint. The operation time, intraoperative and 24 hours postoperative blood loss, acetabular prosthesis abduction angle, anteversion angle, ratio of acetabular cup in safe area, Harris hip joint function score and complications were recorded. Result: The operation time in the observation group was shorter than that in the control group, and the amount of bleeding during the operation and 24 hours after the operation were less than those in the control group, the differences were statistically significant(P<0.05). One week after operation, Harris hip joint function score in the observation group was higher than that in the control group, and the shortened length of the affected limb was less than that in the control group(P<0.05). The average abduction angle and anteversion angle of acetabular prosthesis in the two groups were within the normal safety range, one week after operation, the abduction angle in the observation group was greater than that in the control group, while the anteversion angle was less than that in the control group, the differences were statistically significant(P<0.05). There was no significant difference in the incidence of complications between the two groups(P>0.05). Conclusion: The strategy of "one-time grinding technique" for patients undergoing hip replacement surgery is not only helpful to shorten the operation time and reduce the amount of intraoperative bleeding, but also can effectively improve the hip joint function of patients, without increasing the risk of complications. It is safe and worthy of clinical application.