后路小切口人工全髋关节置换术

目的 观察后路小切口人工全髋关节置换术（total hip arthroplasty，THA）的临床效果。方法 将70例患者按年龄、性别、体重指数、病种、髋关节功能配对分为两组进行前瞻性研究。35例小切口组，术前Harris评分52．21（24～76），35例标准后路手术组（简称标准组），术前Harris评分51．6（33～68）。分析手术时间、术中出血＋术后12h引流量、并发症、切口长度、疼痛评分、Harris评分等。结果 平均随访11.5个月（6～14个月）。两组手术时间相近。小切口组平均切口长9．0cm（7．0～12cm），标准组16cm（12—20cm），两组差异有统计学意义（P〈0．01）；小切口组平均出血500ml（270～700m1），29％（10／35）需输血，输血量约400ml，而标准组平均出血约950ml（600～1200m1），100％需输血，平均输血650ml，小切口组明显比标准组具有优势（P〈0．05）；小切口组疼痛评分平均为4．8分，标准组为6．8分（P〈0.01）。术后6个月，小切口组Harris评分94．0（84～100），标准组Harris评分90．5（82～94）。结论 后路小切口微创技术具有创伤小、出血少、疼痛小、恢复快的特点，可获得与常规后路手术相同的冶疗效果。

Minimally invasive total hip arthroplasty with posterior incision

Objective To observe the clinical results of minimally invasive total hip arthroplasty (THA) with posterior incision. Methods Matched by age, gender,body mass index (BMI), disease and preoperative Harrie Hip Score, 70 cases were classified into two groups for a prospective study. Of all, 35 cases (Group A) treated with a minimally invasive THA had 52.21 scores (24-76 scores) preoperatively and the other 35 cases (Group B) treated with THA with standard posterior incision had preoperative score of 51.6 (33-68 scores). An analysis was done on operation time, intraoperative hemorrhage plus drainage volume after 12 hours, complications, incision length, pain score and Harris score. Results The follow up time was mean 11.5 months (6-14 months). The average operation time was 69 minutes (57-90 minutes) for Group A and 65 minutes (55-78 minutes) for Group B,with insignificant difference between both groups. The average incision length for Group A was 9.0 cm (7-12 cm) and 16 cm (12-20 cm) for Group B (P<0.01). The average blood loss for Group A was 500 ml (270-700 ml) and 950 ml (600-1 200 ml) for Group B. In Group A,10 cases (29%) received blood transfusion for 400 ml, with significant advantage compared with Group B, in which all cases needed blood transfusion for average 650 ml (P < 0.05). The average post-operative pain score was 4.8 in Group A and 6.8 in Group B (P<0.01). Six months after operation, Harris score was 94.0 (84-100) in Group A and 90.5 (82-94) in Group B, respectively. Conclusions Minimally invasive THA with posterior incision has the advantages of less soft tissue damage, less blood loss, less pain and quick recovery and can obtain same clinical result as that of traditional THA with posterior approach.