中国修复重建外科杂志

中国修复重建外科杂志

SuperPATH 与后外侧入路行人工全髋关节置换术的随机对照研究

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目的 对 SuperPATH 入路与传统后外侧入路行人工全髋关节置换术(total hip arthroplasty,THA)的疗效进行比较。 方法 2017 年 3 月—5 月,将 24 例拟行初次单侧 THA 的髋关节疾病患者纳入研究,随机分为两组(n=12),分别采用 SuperPATH 入路(SuperPATH 组)及传统后外侧入路(对照组)进行关节置换。两组患者性别、年龄、体质量指数、疾病类型、合并基础疾病类型、美国麻醉医师协会(ASA)分级等一般资料比较,差异均无统计学意义(P>0.05)。记录两组手术时间、住院时间、切口长度以及手术相关并发症发生情况;手术前后血红蛋白和红细胞压积,计算总失血量及术中失血量;手术前后炎性反应指标(C 反应蛋白、红细胞沉降率)、肌肉损伤指标(肌酸激酶),患者髋关节屈曲及外展活动度、髋关节功能 Harris 评分、疼痛视觉模拟评分(VAS);摄骨盆正位 X 线片观察假体位置。 结果 两组患者均获 1 年随访。与对照组相比,SuperPATH 组手术时间明显延长(t=4.470,P=0.000)、手术切口缩短(t=–2.168,P=0.041),住院时间无显著差异(t=0.474,P=0.640)。SuperPATH 组术中 1 例发生假体周围骨折;两组术后均无感染、下肢深静脉血栓形成等并发症发生。两组术中失血量及总失血量,术前及术后 1、3 d 血红蛋白和红细胞压积,术前及术后 1、3、14 d C 反应蛋白及红细胞沉降率比较,差异均无统计学意义(P>0.05)。SuperPATH 组术后 1、3 d 肌酸激酶明显低于对照组(P<0.05),术前及术后 14 d 比较差异无统计学意义(P>0.05)。术后 1、3 d SuperPATH 组髋关节屈曲及外展活动度均优于对照组(P<0.05),但 14 d、3 个月、6 个月及 1 年比较差异均无统计学意义(P>0.05)。SuperPATH 组术后 1、3 d Harris 评分及 VAS 评分明显优于对照组(P<0.05),其余各时间点差异均无统计学意义(P>0.05)。术后 1 年复查 X 线片,两组前倾角及外展角比较差异无统计学意义(P>0.05)。随访期间两组假体均无松动、下沉。 结论 与后外侧入路相比,采用 SuperPATH 入路行 THA 能减少肌肉损伤、减轻术后早期疼痛,促进患者早期康复。

Objective To evaluate the effectiveness of SuperPATH approach in total hip arthroplasty (THA) compared with conventional posterolateral approach. Methods Between March 2017 and May 2017, 24 patients who planned to have a unilateral THA were enrolled in the study and randomized into 2 groups. Twelve patients were treated with SuperPATH approach (SuperPATH group) and 12 patients with posterolateral approach (control group). There was no significant difference in gender, age, body mass index, the type of disease, complicating diseases, and American Society of Anesthesiologists grading between 2 groups (P>0.05). The operation time, length of stay, length of incision, and perioperative complications related to operation were recorded. The hemoglobin and hematocrit were recorded; the total blood loss and intraoperative blood loss were calculated. The inflammatory response indicators (C-reactive protein, erythrocyte sedimentation rate) and muscle damage index (creatine kinase) were recorded in both groups. The range of motion, functional score (Harris score), visual analogue scale (VAS) score, and prosthesis position were recorded. Results Patients in both groups were followed up 1 year. Compared with the control group, the operation time of the SuperPATH group was longer (t=4.470, P=0.000), and the incision was shorter (t=–2.168, P=0.041). There was no significant difference in length of stay between 2 groups (t=0.474, P=0.640). Periprosthetic fracture occurred in 1 case of the SuperPATH group. No other complications, such as infection or deep vein thrombosis, occurred in both groups. There was no significant difference in intraoperative blood loss, total blood loss, hemoglobin and hematocrit before operation and at 1 and 3 days after operation, and C-reactive protein and erythrocyte sedimentation rate before operation and at 1, 3, and 14 days between 2 groups (P>0.05). For creatine kinase, SuperPATH group at 1 and 3 days were lower than control group (P<0.05), while no significant difference was found between 2 groups before operation and at 14 days after operation (P>0.05). For flexion and abduction activity, SuperPATH group at 1 and 3 days after operation were better than the control group (P<0.05), while no significant difference was found between 2 groups at 14 days, 3 months, 6 months, and 1 year after operation (P>0.05). The Harris and VAS scores of SuperPATH group at 1 and 3 days after operation were better than those of control group (P<0.05). There was no significant difference in anteversion and abduction between 2 groups (P>0.05) according to the X-ray film at 1 year. During the follow-up, no loosening or migration was observed. Conclusion Compared with the posterolateral approach, the SuperPATH approach can reduce muscle damage, relieve early pain, promote recovery, and obtain the similar short-term effectiveness.

关键词: 人工全髋关节置换术; SuperPATH 入路; 后外侧入路; 微创

Key words: Total hip arthroplasty; SuperPATH approach; posterolateral approach; minimally invasive

引用本文: 欧阳晨波, 王浩洋, 孟维锟, 罗泽宇, 王端, 裴福兴, 周宗科. SuperPATH 与后外侧入路行人工全髋关节置换术的随机对照研究. 中国修复重建外科杂志, 2018, 32(12): 1500-1506. doi: 10.7507/1002-1892.201807011 复制

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