[1]李文龙,范亚楠,张蕾蕾,等.微创全髋关节置换术直接前侧入路 与外侧小切口入路的对比研究[J].中医正骨,2016,28(03):24-29.
　LI Wenlong,FAN Yanan,ZHANG Leilei,et al.A clinical comparison of direct anterior approach versus lateral small-incision approach in minimal invasive surgery total hip arthroplasty[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(03):24-29.
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微创全髋关节置换术直接前侧入路 与外侧小切口入路的对比研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第28卷
期数:
2016年03期
页码:
24-29
栏目:
骨科微创技术
出版日期:
2016-03-20

文章信息/Info

Title:
A clinical comparison of direct anterior approach versus lateral small-incision approach in minimal invasive surgery total hip arthroplasty
作者:
李文龙1; 范亚楠1; 张蕾蕾1; 马向浩1; 张颖2; 王会超 2; 刘又文2
1.河南中医药大学,河南 郑州 450008;
2.河南省洛阳正骨医院/河南省骨科医院,河南 洛阳 471002
Author(s):
LI Wenlong1; FAN Yanan1; ZHANG Leilei1; MA Xianghao1; ZHANG Ying2; WANG Huichao2; LIU Youwen2
1.Henan University of Chinese Medicine,Zhengzhou 450008,Henan,China 2.Luoyang Orthopedic-Traumatological Hospital,Luoyang 471002,Henan,China
关键词:
关节成形术; 置换; 髋;  手术入路;  外科手术; 微创性;  治疗; 临床研究性
Keywords:
arthroplasty; replacement; hip;  operative approach;  surgical procedures; minimally invasive;  therapies; investigational
摘要:
目的:比较微创全髋关节置换术(minimal invasive surgery total hip arthroplasty,MIS-THA)直接前侧入路与 外侧小切口入路在手术创伤、临床疗效及安全性方面的差异。方法:选取71例接受单侧MIS-THA手术的患者,33例采用直接 前侧入路(前侧入路组)、38例采用外侧小切口入路(外侧入路组)。记录并比较2组患者的切口长度、手术时间、术中出血 量、输血量、术后红细胞沉降率(erythrocyte sedimentation rate,ESR)、术后C反应蛋白(C-reactive protein,CRP)含 量、手术前后血红蛋白差值、住院时间及并发症发生情况。术后血红蛋白含量、ESR、CRP含量在术后第2天测定。定期随 访,测定患侧髋臼外展角和前倾角,并采用髋关节Harris评分量表评定髋关节功能。结果:与外侧入路组相比,前侧入路组 切口较小、手术时间长、术中出血少、输血少、术后ESR低、CRP含量低、手术前后血红蛋白差值小、住院时间短 [(7.24±0.61)cm,(9.74±0.92)cm,t=-13.852,P=0.000;(67.39±10.71)min,(61.84±5.33) min,t=2.702,P=0.010;(255.30±20.22)mL,(364.95±30.79)mL,t=-177.441,P=0.000;(1.85±1.20)单位, (3.47±1.29)单位,t=-5.467,P=0.000;(55.33±7.23)mm·h-1,(78.74±13.91)mm·h- 1,t=-9.058,P=0.000;(36.51±3.66)mg·L-1,(55.81±7.07)mg·L-1,t=- 14.712,P=0.000;(22.18±14.53)g·L-1,(30.76±15.22)g·L-1,t=-2.420,P=0.018; (9.22±1.01)d,(10.83±1.63)d,t=-5.062,P=0.000]。术后6个月2组患者的髋臼前倾角、髋臼外展角比较,组间 差异均无统计学意义(20.15°±5.32°,21.21°±3.66°,t=-0.963,P=0.340; 38.21°±4.28°,38.63°±3.12°,t=-0.466,P=0.643)。术前2组患者的Harris评分比较,差异无统计学意义 (t=1.190,P=0.238); 术后6个月2组患者的评分均增加[(39.12±11.47)分,(90.76±3.76)分,t=- 26.055,P=0.000;(42.21±10.41)分,(89.47±3.41)分,t=-27.015,P=0.000]; 2组患者手术前后Harris评分差值 比较,组间差异无统计学意义[(51.64±11.39)分,(47.26±10.79)分,t=1.661,P=0.101]。前侧入路组1例发生股 外侧皮神经损伤、2例发生阔筋膜张肌损伤,外侧入路组2例出现血肿、3例因术中拉钩牵拉造成皮肤挫伤; 2组患者的并发 症发生率比较,差异无统计学意义(P=0.716)。结论:采用直接前侧入路和外侧小切口入路行MIS-THA手术,临床疗效和安全 性相当,均可有效改善患者髋关节功能,术后人工关节稳定性好、并发症少。但直接前侧入路创伤较小,有利于患者术后康 复。
Abstract:
Objective:To compare direct anterior approach versus lateral small-incision approach in the operation wound,clinical curative effect and safety in minimal invasive surgery total hip arthroplasty (MIS-THA).Methods:Seventy-one patients were treated with unilateral MIS-THA,33 patients through direct anterior approach(anterior approach group),38 patients through lateral small-incision approach(lateral approach group).The incision length,operative time,blood loss,blood transfusions,postoperative erythrocyte sedimentation rate(ESR),postoperative C-reactive protein(CRP)contents,difference of hemoglobin between pre-operation and postoperation,hospital stay and complications were recorded and compared between the 2 groups.The postoperative CRP contents,ESR and CRP contents were measured at the 2nd day after the surgery.Regular follow-up was carried out for the patients.The acetabular abduction and anteversion angles of the affected side were measured,and the hip joint function were evaluated by using Harris hip scoring scale.Results:The anterior approach group had smaller incision,longer operation time,less blood loss,less blood transfusion,lower postoperative ESR and CRP contents,smaller difference of hemoglobin between pre-operation and postoperation and shorter hospital time compared to the lateral approach group (7.24+/-0.61 vs 9.74+/-0.92 cm,t=-13.852,P=0.000; 67.39+/-10.71 vs 61.84+/-5.33 min,t=2.702,P=0.010; 255.30+/-20.22 vs 364.95+/-30.79 ml,t=-177.441,P=0.000; 1.85+/-1.20 vs 3.47+/-1.29 units,t=- 5.467,P=0.000; 55.33+/-7.23 vs 78.74+/-13.91 mm/h,t=-9.058,P=0.000; 36.51+/-3.66 vs 55.81+/-7.07 mg/l,t=-14.712,P=0.000; 22.18+/-14.53 vs 30.76+/-15.22 g/l,t=-2.420,P=0.018; 9.22+/-1.01 vs 10.83+/-1.63 days,t=-5.062,P=0.000).There was no statistical difference in the acetabular front rake and acetabular angles of anteversion and abduction between the 2 groups at the 6 months after the surgery(20.15+/-5.32 vs 21.21+/-3.66 degrees,t=-0.963,P=0.340; 38.21+/-4.28 vs 38.63 +/-3.12 degrees,t=-0.466,P=0.643).There was no statistical difference in the Harris scores between the 2 groups before the surgery (t=1.190,P=0.238).The Harris scores increased in the 2 groups at the 6 months after the surgery(39.12+/- 11.47 vs 90.76+/-3.76 points,t=-26.055,P=0.000; 42.21+/-10.41 vs 89.47+/-3.41 points,t=- 27.015,P=0.000).There was no statistical difference between the 2 groups in the difference of Harris scores between pre-operation and postoperation(51.64+/-11.39 vs 47.26+/-10.79 points,t=1.661,P=0.101).The nervus cutaneus femoris lateralis injury(1 case)and tensor fasciae latae injury(2 cases)were found in the anterior approach group,while hematoncus(2 cases)and skin contusion(3 cases)caused by intraoperative traction with draw hook were found in the lateral approach.There was no statistical difference in the incidences of complications between the 2 groups(P=0.716).Conclusion:Direct anterior approach is similar to lateral small-incision approach in clinical curative effect and safety in the MIS-THA,and the MIS-THA through both of the two approachs can effectively improve hip joint function with good postoperative stability of joint prosthesis and few complications.However,the former has less injury,which is beneficial to postoperative recovery.

参考文献/References:

[1] 朱俊昭,王福贵,邹扬道,等.人工髋关节置换术后并发症临床分析及处理对策[J].中国伤残医学,2010,18(5):9-11.
[2] 张健,周爱国.经后方及外侧小切口微创全髋关节置换入路的比较研究[J].重庆医科大学学报,2007,32(9):991-993.
[3] Hallert O,Li Y,Brismar H,et al.The direct anterior approach: initial experience of a minimally invasive technique for total hip arthroplasty[J].J Orthop Surg Res,2012,7:17.
[4] Crowe JF,Mani VJ,Ranawat CS.Total hip replacement in congenital dislocation and dysplasia of the hip [J].J Bone Joint Surg Am,1979,61(1):15-23.
[5] Harris WH.Traumatic arthritis of the hip after dislocation and acetabular fractures:treatment by mold arthroplasty.An end-result study using a new method of result evaluation[J].J Bone Joint Surg Am,1969,51 (4):737-755.
[6] Witzleb WC,Stephan L,Krummenauer F,et al.Short-term outcome after posterior versus lateral surgical approach for total hip arthroplasty - A randomized clinical trial[J].Eur J Med Res,2009,14(6):256-263. 中医正骨2016年3月第28卷第3期 J Trad Chin Orthop Trauma,2016,Vol.28,No.3(总189) (总190)中医正骨2016年3月第28卷第3期 J Trad Chin Orthop Trauma,2016,Vol.28,No.3
[7] 桑伟林,朱力波,马金忠,等.微创直接前入路全髋关节置换术[J].国际骨科学杂志,2010,31(5):266-267.
[8] Smith-Petersen MN.Approach to and exposure of the hip joint for mold arthroplasty[J].J Bone Joint Surg Am,1949,31A(1):40-46.
[9] Jewett BA,Collis DK.High complication rate with anterior total hip arthroplasties on a fracture table[J].Clin Orthop Relat Res,2011,469(2):503-507.
[10] 桑伟林,朱力波,陆海明,等.直接前入路与后外侧入路全髋关节置换术的对比研究[J].中华关节外科杂志:电子 版,2015,9(5):584-588.
[11] Rodriguez JA,Deshmukh AJ,Rathod PA,et al.Does the direct anterior approach in THA offer faster rehabilitation and comparable safety to the posterior approach?[J].Clin Orthop Relat Res,2014,472(2):455 -463.
[12] 宋炎成,张慧慧,卢华定,等.CRP、ESR在关节置换手术前后变化及其临床意义[J].中国矫形外科杂志,2008,16 (11):823-825.
[13] Morrey BF.Instability after total hip arthroplasty[J].Orthopedic Clinics of North America,1992,23 (2):237-248.
[14] Lewinnek GE,Lewis JL,Tarr R,et al.Dislocations after total hip-replacement arthroplasties[J].J Bone Joint Surg Am,1978,60(2):217-220.
[15] Siguier T,Siguier M,Brumpt B.Mini-incision anterior approach does not increase dislocation rate:a study of 1037 total hip replacements[J].Clin Orthop Relat Res,2004,(426):164-173.
[16] Matta JM,Shahrdar C,Ferguson T.Single-incision anterior approach for total hip arthroplasty on an orthopaedic table[J].Clin Orthop Relat Res,2005,441:115-124.

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备注/Memo

备注/Memo:

通讯作者:刘又文 E-mail:liuyouwen543@sina.com
更新日期/Last Update: 2016-03-30