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微创与常规全髋关节置换术的早期临床比较

曹文,薛桂松   

  1. 天津市天和医院
  • 收稿日期:2012-05-09 修回日期:2012-06-14 出版日期:2012-09-15 发布日期:2012-09-15
  • 通讯作者: 曹文

Retrospective comparison of total hip arthroplasty through a minimally invasion versus standard posterolateral approach

  • Received:2012-05-09 Revised:2012-06-14 Published:2012-09-15 Online:2012-09-15

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摘要： [摘要]：目的 比较微创与常规全髋关节置换术的早期临床效果及相关手术经验。方法 髋关节髋前入路双切口法行微创THA患者30例30髋，男22例22髋，女8例8髋；年龄42-74岁，平均64.2岁；体重指数19.2-26.7 kg／m2，平均23.4kg／m2。疾病分类：股骨头缺血坏死7髋，骨关节炎7髋，老年股骨颈移位骨折16髋。术前Harris评分25-37分，平均31.9分。同期采用常规后外侧入路行THA患者30例30髋，男19例19髋，女11例11髋；年龄47-70岁，平均62.4岁；体重指数21.1-25.8 kg／m2，平均23.2 kg／m2。疾病分类：股骨头缺血坏死6髋，骨关节炎9髋, 老年股骨颈移位骨折15髋。术前Harris评分平均27-40分，平均32.2分。两组病例均使用非骨水泥假体。对两组病例的手术时间、出血量、切口长度、并发症、术后疼痛程度、术后住院时间、术后功能康复进行比较。结果 术后随访24个月，平均23.2个月，两组病例均未出现感染、骨折脱位及神经损伤等并发症，常规手术组有1例切口脂肪液化延迟愈合，4例下肢深静脉栓塞，3例术后2个月发生假体脱位。微创组的切口长度、术中出血均显著短于传统手术组(P值<0.01)，手术时间、输血量及术后引流量均明显少于常规手术组(P值<0.05)。微创组术后3天疼痛发生率、下地负重时间均显著小于常规手术组(P值均<0.05)，术后1、6个月的患髋Harris评分均明显高于常规手术组(P值均<0.05)，但术后一年患髋Harris评分两组之间无统计学差异。结论 在恰当选择手术适应证的前提下微创全髋关节置换术，能通过减少软组织的损伤，达到减轻术后疼痛、缩短住院时间和加快术后康复的目的。

关键词: 关节成形术, 置换, 髋, 微创性, 临床比较

Abstract: 【Abstract】0bjective To evaluate the clinical outcome of total hip arthroplasty through a minimally invasion and summarize the surgical experience .Methods thirty cases of THA were performed through minimally invasive anterial surgical approach(MIS group)．Among them，there were 22 males and 8 females，the mean age was 64.2 years and the mean BMI was 23.4kg／m2 and the mean Harris score was 31.9．For comparison，another 30 cases of THA were performed through a standard posterolateral approach at the same period(standard group)．the mean age，BMI and Harris score were similar to the MIS group．Operation time，blood loss，incision length，complication，postoperative VAS pain score，postoperative hospitalization，functional recovery were analysed and compared between the above two groups．Results These patients were followed up for average one year，no infection，fracture and neurovascular injury occurred in both groups．There were one skin late healed 、four deep venous thrombosis and three dislocation in standard group．There were big significant differences regarding operation time and incision length in the two groups．There were significant differences regarding the complications，postoperative VAS pain score，postoperative hospitalization，functional recovery of one month and six months, but there were no significant differences regarding the functional recovery of one year after operation． Conclusion THA through a minimally invasive anterial surgical approach is an effective and reproducible operative technique．The advantages of MIS THA includes less postoperative pain，shorter post-operative hospitalization and faster rehabilitation．．But the selection of suitable patients for mini-incision THA should be noticed.

Key words: Arthroplasty, replacement, hip, Minimally invasive, Follow-up studies