中国组织工程研究 ›› 2018, Vol. 22 ›› Issue (35): 5583-5589.doi: 10.3969/j.issn.2095-4344.1003

• 人工假体 artificial prosthesis • 上一篇    下一篇

全髋关节置换直接前入路与后外侧入路患者的早期疗效比较

查小伟,程文丹,吕 浩,李子煜,刘 伟,祁 雷,余水生,荆珏华   

  1. 安徽医科大学第二附属医院骨科,安徽省合肥市   230000
  • 出版日期:2018-12-18 发布日期:2018-12-18
  • 通讯作者: 荆珏华,博士,教授,主任医师,博士生导师,安徽医科大学第二附属医院骨科,安徽省合肥市 230000
  • 作者简介:查小伟,男,1992年生,安徽省合肥市人,汉族,2016级安徽医科大学在读硕士,主要从事关节外科方向的研究。
  • 基金资助:

    国家自然科学基金面上项目(81671204);安徽省自然科学基金面上项目(1608085MH167)

Early effects of direct anterior approach versus posterolateral approach in total hip arthroplasty  

Zha Xiaowei, Cheng Wendan, Lü Hao, Li Ziyu, Liu Wei, Qi Lei, Yu Shuisheng, Jing Juehua   

  1. Department of Orthopedics, the Second Hospital of Anhui Medical University, Hefei 230000, Anhui Province, China
  • Online:2018-12-18 Published:2018-12-18
  • Contact: Jing Juehua, MD, Professor, Chief physician, Doctoral supervisor, Department of Orthopedics, the Second Hospital of Anhui Medical University, Hefei 230000, Anhui Province, China
  • About author:Zha Xiaowei, Master candidate, Department of Orthopedics, the Second Hospital of Anhui Medical University, Hefei 230000, Anhui Province, China
  • Supported by:

    the National Natural Science Foundation of China (General Program), No. 81671204; the Natural Science Foundation of Anhui Province (General Program), No. 1608085MH167

摘要:

文章快速阅读

 
 

 

文题释义:
微创全髋关节置换:是一项新技术,它与传统手术相比具有康复快、疼痛轻等优点,分为两大类:一类是传统全髋关节置换的基础上缩小皮肤切口,该类手术中最为经典的为Gibson入路等,这并不是完全微创;另一类则是在新的解剖位置入路,此入路强调从肌肉间隙进入,不切断关节周围肌肉组织,极大地保护了神经血管肌肉,真正符合微创要求,其中以直接前侧入路最为经典。
直接前入路:为Smith-Petersen入路基础上的一种改良入路,与Smith-Petersen入路相比直接前侧入路切口更靠外侧,从阔筋膜张肌、缝匠肌和股直肌之间的解剖间隙(Hueter 间隙)穿过,真正实现在神经血管和肌间界面操作手术。该方法组织损伤较轻、术后功能恢复快,近年来在国内外得到广泛应用。但是该手术入路操作困难,学习曲线较长,对术者及手术室硬件有一定要求。
 
摘要
背景:目前微创全髋关节置换逐渐发展成为全髋关节置换最受欢迎的手术方式,而直接前入路具有软组织损伤小、术后恢复快等优点,被称为最符合微创手术标准的全髋置换入路,但是该入路操作难度大,学习曲线长,与其他入路相比是否能取得较好的早期疗效仍存争议。
目的:比较分析全髋关节置换后外侧入路和直接前入路对组织损伤及早期临床疗效的影响。
方法:回顾性分析2016年10月至2017年8月在安徽医科大学第二附属医院骨科接受全髋关节置换64例患者的临床资料。根据手术入路分为直接前入路组(31例)和后外侧入路组(33例)。比较2组手术切口长度、手术时间、术中出血量、术后住院时间、术后引流量、肌酸激酶、C-反应蛋白、红细胞沉降率、白细胞介素6、疼痛目测类比评分、Harris髋关节功能评分及并发症。
结果与结论:①与后外侧入路组相比,直接前入路组手术时间较长、术中出血较多、手术切口较短、术后住院时间较短,差异有显著性意义(P < 0.05);2组术后引流量差异无显著性意义(P > 0.05);②直接前入路组置换后第1,2,3,4天血清肌酸激酶、C-反应蛋白、血沉、白细胞介素6水平均低于后外侧入路组(P < 0.05);③术后24,48,72 h直接前入路组疼痛目测类比评分低于后外侧入路组(P < 0.05);④2组患者均随访6个月,术后1,3,6个月时直接前入路组Harris髋关节功能评分均优于后外侧入路组(P < 0.05);⑤2组置换后髋臼假体前倾角和外展角差异无显著性意义(P > 0.05);⑥2组置换后并发症差异无显著性意义(P=1.00);⑦综上,直接前路与后外侧入路术后随访6个月早期并发症无明显差异,相对于后外侧入路全髋关节置换,直接前方入路可获得较小的软组织创伤,较好的早期临床疗效,髋关节功能改善更佳。

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程
ORCID: 0000-0003-2084-6209(查小伟)

关键词: 直接前方入路, 后外侧入路, 全髋关节置换术, 疼痛, 髋关节功能, 国家自然科学基金

Abstract:

BACKGROUND: Minimally invasive total hip arthroplasty is becoming the most popular procedure for total hip arthroplasty. Direct anterior approach has the advantages of small soft tissue injury and quick recovery after operation, so it is called the best approach of total hip replacement according to the minimally invasive surgical criteria. However, it is difficult to operate and the learning curve is long, and early curative effect remains controversial.

OBJECTIVE: To compare the tissue injury and early clinical effect between direct anterior approach and posterolateral approach in total hip arthroplasty.
METHODS: Clinical data of 64 patients undergoing total hip arthroplasty in the Department of Orthopedics, the Second Hospital of Anhui Medical University from October 2016 to August 2017, were analyzed retrospectively. The patients were divided into direct anterior approach group (n=31) and posterolateral approach group (n=33) according to the operative approach. The incision length, operation time, intraoperative blood loss, hospitalization time, drainage volume, serum creatine kinase, C-reactive protein, erythrocyte sedimentation rate, interleukin-6, Visual Analogue ScaIe score, the Harris hip score, and complications were compared between two groups.
RESULTS AND CONCLUSION: (1) The direct anterior approach group showed significant longer operation time, more intraoperative blood loss, shorter incision length and shorter hospitalization time than those in the posterolateral approach group (P < 0.05). The drainage volume showed no significant difference between two groups (P > 0.05). (2) The levels of creatine kinase, C-reactive protein, and interleukin-6, and erythrocyte sedimentation rate at 1, 2, 3, and 4 days postoperatively in the direct anterior approach group were significantly lower than those in the posterolateral approach group (P < 0.05). (3) The Visual Analogue Scale scores at postoperative 24, 48, and 72 hours in the direct anterior approach group were significantly lower than those in the posterolateral approach group (P < 0.05). (4) The Harris hip scores at 1, 3 and 6 months postoperatively in the direct anterior approach group were significantly superior to those in the posterolateral approach group  (P < 0.05). (5) There was no significant difference in the anteversion or abduction angles of acetabular prosthesis between two groups (P > 0.05). (6) The surgical complications showed no significant differences between two groups (P=1.00). (7) To conclude, there is no significant difference in 6-month complications between direct anterior approach and posterolateral approach. Direct anterior approach in total hip arthroplasty achieves less muscle damage, better early-term clinical effect and better functional recovery compared with the posterolateral approach.

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程

Key words: Arthroplasty, Replacement, Hip, Surgical Operation, Invasive, Tissue Engineering

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