中国修复重建外科杂志

中国修复重建外科杂志

不同手术入路行初次人工全髋关节置换术的近期疗效比较

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目的 比较采用 Bikini 切口直接前入路和前外侧入路行初次人工全髋关节置换术(total hip arthroplasty,THA)的近期疗效差异。 方法 将 2015 年 6 月—2016 年 3 月收治并符合选择标准的 60 例股骨头缺血性坏死患者纳入研究。根据手术入路不同分为两组,30 例行 Bikini 切口直接前入路 THA(A 组),30 例行前外侧入路 THA(B 组)。两组患者性别、年龄、体质量指数、患髋侧别、股骨头缺血性坏死 Steinberg 分期以及术前血红蛋白、Harris 评分、疼痛视觉模拟评分(VAS)比较,差异均无统计学意义(P>0.05),具有可比性。记录并比较两组患者手术时间、切口长度、术中出血量、输血率、开始直腿抬高功能锻炼时间、开始髋关节主动外展时间、住院时间、双下肢不等长发生率,以及髋关节 Harris 评分、VAS 评分;复查骨盆正位 X 线片,测量髋臼杯外展角和前倾角。 结果 两组患者术后切口均Ⅰ期愈合,A、B 组并发症发生率比较,差异无统计学意义(χ2=0.144,P=0.704)。两组患者术后均获随访,随访时间 3~12 个月,平均 6 个月。两组手术时间、切口长度、术中出血量、输血率、住院时间及开始直腿抬高功能锻炼时间比较,差异均无统计学意义(P>0.05)。A 组开始髋关节主动外展时间显著短于 B 组(t=–4.591,P=0.000),双下肢不等长发生率显著低于 B 组(χ2=5.455,P=0.020)。两组术后 2 周、6 周、3 个月、6 个月 Harris 评分以及术后 24 h、6 周 VAS 评分比较,差异均无统计学意义(P>0.05)。骨盆正位 X 线片复查示,术后 2 d A、B 组髋臼外展角、前倾角比较差异均无统计学意义(t=0.887,P=0.379;t=0.652,P=0.517);所有假体位置良好,无股骨假体下沉、髋臼杯移位或关节脱位等情况发生。 结论 采用两种手术入路进行微创 THA 均能避免肌肉损伤,并取得良好近期疗效。但与前外侧入路相比,Bikini 切口直接前入路在术后患者开始髋关节主动外展时间和双下肢不等长发生率方面具有一定优势。

Objective To compare the early effectiveness between by anterior approach via Bikini incision and by OCM approach in the primary total hip arthroplasty (THA). Methods Between June 2015 and March 2016, 60 patients with ischemic necrosis of the femoral head who accorded with the inclusion criteria were chosen in the study, who were divided into 2 groups according to different surgical approaches. THA was performed on 30 patients by anterior approach via Bikini incision (group A), and on 30 patients by OCM approach (group B). There was no significant difference in age, gender, body mass index, side of affected hip, Steinberg stage of ischemic necrosis of femoral head, preoperative hemoglobin, preoperative Harris score, and preoperative visual analogue scale (VAS) between 2 groups (P>0.05). The operation time, length of incision, intraoperative blood loss, transfusion rate, starting time of straight leg raising exercise, starting time of active abduction of hip, hospitalization time, the incidence of limb length discrepancy, postoperative Harris score and VAS score were recorded and compared between 2 groups. Anteroposterior pelvic X-ray films were taken to measure acetabular abduction and acetabular anteversion. Results Primary healing of incision was obtained in all patients of 2 groups, and there was no significant difference in complication between 2 groups (χ2=0.144,P=0.704). All the patients of 2 groups were followed up 3 to 12 months, averaged 6 months. There was no significant difference in operation time, length of incision, intraoperative blood loss, transfusion rate, hospitalization time, and starting time of straight leg raising exercise between 2 groups (P>0.05). Group A was significantly shorter than group B in starting time of active abduction of hip (t=–4.591,P=0.000), and was significantly lower than group B in the incidence of limb length discrepancy (χ2=5.455,P=0.020). After operation, neither Harris score at 2 weeks, 6 weeks, 3 months, and 6 months nor VSA score at 24 hours and 6 weeks showed significant difference between 2 groups (P>0.05). The anteroposterior pelvic X-ray films showed that all the prostheses were in good position, and there was no femoral prosthesis subsidence, acetabular cup displacement or dislocation. No significant difference was found in acetabular abduction and acetabular anteversion at 2 days after operation between 2 groups (t=0.887,P=0.379;t=0.652,P=0.517). Conclusion Both of two approaches in THA can avoid muscle damage and achieve favorable short-term effectiveness. But, anterior approach via Bikini incision is superior to OCM approach in starting time of active abduction of hip and the incidence of limb length discrepancy.

关键词: 微创手术; 人工全髋关节置换术; Bikini 切口直接前入路; 前外侧入路

Key words: Minimally invasive operation; total hip arthroplasty; anterior approach via Bikini incision; OCM approach

引用本文: 徐亦鹏, 孙绍婷, 王佳佳, 张海宁. 不同手术入路行初次人工全髋关节置换术的近期疗效比较. 中国修复重建外科杂志, 2017, 31(4): 397-403. doi: 10.7507/1002-1892.201610104 复制

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