SuperPATH入路松解梨状肌全髋关节置换术的早期疗效

Early clinical efficacy of the SuperPATH approach in releasing the piriformis muscle in total hip arthroplasty

目的:评价SuperPATH入路全髋关节置换术(THA)松解梨状肌的早期疗效。方法:选择2020年1—12月进行THA的60例患者进行前瞻性研究。采用随机数字表法随机分为2组,每组各30例。两组患者均采用SuperPATH入路进行THA,根据术中是否松解梨状肌分为松解梨状肌THA组和不松解梨状肌THA组。最终松解梨状肌THA组22例患者、不松解梨状肌THA组25例患者纳入最后分析。比较两组患者手术时间(切皮开始至皮肤缝合完毕)、术中出血量、总失血量、切口长度、住院时间,术后不同时间点起立行走时间(TUG)、髋关节Harris评分、疼痛视觉模拟(VAS)评分及下肢长度差异、髋臼前倾角、髋臼外翻角,同时观察并发症发生情况。结果:松解梨状肌THA组患者手术时间较不松解梨状肌THA组患者明显缩短,且差异有统计学意义(P<0.05)。两组患者住院时间比较差异无统计学意义(P>0.05)。松解梨状肌THA组患者术中出血量及总失血量少于不松解梨状肌THA组患者,且差异有统计学意义(P<0.05)。随着时间推移,两组患者术后疼痛VAS评分比较不存在主体间效应(F=1.662,P=0.204)。术后各时间点两组患者TUG及髋关节Harris评分差异均无统计学意义(P>0.05)。随着时间推移,两组患者间TUG及髋关节Harris评分比较不存在主体间效应(TUG:F=0.036,P=0.850;髋关节Harris评分:F=0.151,P=0.700)。术后1个月,两组患者下肢长度差异及髋臼外翻角差异均无统计学意义(P>0.05),但不松解梨状肌THA组患者髋臼前倾角更大(P<0.05)。两组患者并发症发生率差异无统计学意义[9.1%(2/22)vs.8.0%(2/25),χ^(2)=0.000,P>0.05]。结论:SuperPATH入路THA松解梨状肌可缩短手术时间,减少手术失血,但不影响术后早期疗效。因此建议术中对梨状肌常规进行松解。

Objective:To evaluate the early clinical efficacy of total hip arthroplasty(THA)through the SuperPATH approach in releasing the piriformis muscle.Methods:A prospective study was conducted on 60 patients who underwent THA from January to December 2020.The patients were randomly divided into two groups using the random number table method,with 30 cases in each group.Both groups of patients underwent THA using the SuperPATH approach.The THA group with piriformis muscle release involved releasing the piriformis muscle during surgery,while the non-release group did not.The final analysis included 22 patients in the piriformis muscle release group and 25 patients in the non-release group.The operation time(from skin incision to skin closure),intraoperative blood loss,total blood loss,incision length,length of hospital stay,time up and go test(TUG),hip Harris score,visual analog scale(VAS)pain score,limb length difference,acetabular anteversion angle,acetabular valgus angle and the occurrence of complications were compared between the two groups.Results:The surgical time in the piriformis muscle release group was significantly shorter than that of the non-release group and the difference was statistically significant(P<0.05).There was no significant difference in the length of hospital stay between the two groups(P>0.05).The intraoperative blood loss and total blood loss in the piriformis muscle release group were less than those in the non-release group,and the difference was statistically significant(P<0.05).There was no significant interaction effect between the two groups for postoperative VAS pain scores(F=1.662,P=0.204)over time.There was no statistically significant difference in TUG and hip Harris score between the two groups at each time point after operation(P>0.05).There was no significant interaction effect between the two groups in terms of TUG and hip Harris score(TUG F=0.036,P=0.850;hip Harris score F=0.151,P=0.700)over time.There was no statistically significant difference in lower limb length and acetabular valgus angle between the two groups(P>0.05),but patients in the non-release group had a larger acetabular anteversion(P<0.05).There was no statistically significant difference in the incidence of complications between the two groups(χ^(2)=0.000,P>0.05).Conclusions:Releasing piriformis muscle in THA with the SuperPATH approach can shorten the surgical time and reduce blood loss without affecting early postoperative efficacy.Therefore,it is recommended to routinely release the piriformis muscle during surgery.