采用股骨侧优先髋臼侧联合氨甲环酸纱布填塞在初次人工全髋关节置换术中精确性及安全性的分析

Clinical effect analysis of femur preferentially acetabular combined with tranexamic acid gauze tamponade technique in total hip arthroplasty

目的探讨采用股骨侧优先髋臼侧联合氨甲环酸纱布填塞在初次人工全髋关节置换术(THA)中的精确性及安全性。方法2019年6月至2022年6月,中国人民解放军西部战区总医院骨科行初次THA的患者74例;其中男35例,女39例;平均年龄61(25~83)岁。将患者分为A、B组两组。A组37例采用THA术中股骨侧优先髋臼处理;B组37例采用髋臼侧优先股骨侧处理。所有患者均行后外侧入路,以37°为理想联合前倾角。A组患者术中截除股骨头后,先行股骨髓腔扩髓,当髓腔锉与股骨髓腔大小匹配后,测量髓腔锉的前倾角,取出髓腔锉,股骨髓腔用氨甲环酸注射液浸润的纱布填塞;然后以37°-髓腔锉前倾角为前倾角,40°外展角磨锉髋臼。B组患者术中截除股骨头后,先处理髋臼侧,使用髋臼角度定位器,以15°前倾角、40°外展角磨锉髋臼;然后再行股骨髓腔扩髓。记录两组患者手术时间、术中假体联合前倾角、术中出血量、术后输血率、住院时间及并发症的发生情况。术后1、3、6、12、24个月门诊复查,复查内容为切口愈合情况,包括双侧髋关节正位X线片、血常规(CBC)、血沉(ESR)、C反应蛋白(CRP)等检验指标。结果两组患者手术时间、术中出血量、术后输血率、住院时间及并发症差异均无统计学意义(均P>0.05)。截止随访时间2023年4月,两组患者均未出现感染、假体脱位等严重并发症。但两组假体联合前倾角差异有统计学意义(均P<0.05)。结论初次THA中股骨侧优先髋臼侧联合氨甲环酸纱布填塞可获得跟髋臼侧优先处理一样的角度精确性及安全性,且没有明显增加手术时间、术中出血量、术后输血率及住院时间,值得在临床上推广。

Objective To investigate the accuracy,and safety of femur preferentially acetabular combined with tranexamic acid gauze tamponade technique during total hip arthroplasty.Methods From June 2019 to June 2022,a retrospective analysis has been done on the clinical data about 74 patients were treated with total hip arthroplasty(THA)in the Department of Orthopedics of the General Hospital of Western Theater Command.Among them,35 patients were males,39 females and their age ranges from 25 to 83 years old with an average age 61 years.The 74 patients were divided into two groups by random number table:Group A,37 patients were treated with femur preferentially acetabular during THA.Group B:37 patients were treated with acetabular preferentially femur.All patients were operated on with Hardinge approach and 37°as the ideal combined anteversion angle.In group A,the femoral medullary cavity was broached after the femoral head was ambushed during the operation,and then the anteversion of intramedullary broacher was measured.The femoral medullary cavity was tamponaded by tranexamic acid gauze.After that,the anteversion of the acetabular cup was calculated as 37°minus the anteversion of the broacher,and the acetabular cup was implanted at that anteversion angle and 40°abduction angle.In group B,the femoral medullary cavity was broached after the acetabular was broached with 15°anteversion angle and 40°abduction angle.Operation time,intraoperative prosthesis combined anterior angle,intraoperative blood loss,postoperative blood transfusion rate,length of hospital stay and incidence of complications were recorded in the two groups.Outpatient clinic re-examination was conducted at 1,3,6,12,and 24 months after surgery.The re-examination included wound healing,anteroposteric radiographs of both hip joints,blood routine examination(CBC),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP).Results There were no significant differences in operation time,intraoperative blood loss,postoperative blood transfusion rate,length of hospital stay and complications between two groups(P>0.05).Up to the follow-up time,there were no serious complications such as infection and dislocation of prosthesis in the two groups.There was significant difference in combined anteversion angle between the two groups(P<0.05).Conclusions In the primary THA,the combination of femur preferentially acetabular and tranexamic acid gauze tamponade technique can obtain same accuracy and safety as the acetabular side priority treatment,without increasing intraoperative blood loss and postoperative blood transfusion rate,which is worthy of wide clinical application.