直接前侧微创入路全髋关节置换术临床应用研究

目的探讨直接前侧微创入路全髋关节置换术(THA)的临床应用效果。方法回顾性分析53例行直接前侧微创入路THA患者的临床资料,观察患者并发症发生情况,采用Harris评分评价患者的髋关节功能;通过骨盆正位X线片观察患者的假体位置及假体松动等情况。结果本组病例的平均手术时间为(114.3±38.9)min,平均术中失血量为(496.1±322.4)mL。术前Harris髋关节评分平均为38.9±11.9,术后12个月为93.2±14.6,术后Harris髋关节评分显著高于术前(t=-2.689,P=0.008)。臼杯前倾角平均为18.0°±7.6°,外展角平均为46.1°±8.5°。体质量指数与术中失血量及臼杯前倾角之间无显著相关性(r=0.102,P=0.089;r=0.112,P=0.075),但与手术时间(r=0.178,P=0.036)及臼杯外展角(r=0.154,P=0.028)呈弱正相关关系;手术时间随着手术例数的增加有减少趋势。术中发生手术切口周围神经损伤2例(3.8%),股骨近端骨折2例(3.8%);术后发生深静脉血栓形成3例(5.6%),髋关节脱位3例(5.6%);并发症发生率为20.8%。结论直接前侧微创入路THA创伤小,手术时间短,患者术后恢复快,有利于保留髋关节周围肌群正常张力,维持髋关节稳定。采用直接前侧微创入路THA,应熟练掌握手术技术,避免并发症的发生,以保证获得良好的手术效果。

Application of direct anterior minimally invasive approach in total hip arthroplasty

Objective To investigate the effect of direct anterior minimally invasive approach in total hip arthroplasty （THA）. Methods The clinical data of 53 patients who underwent THA by direct anterior minimally invasive approach were analyzed retrospectively. The complications were observed. The hip joint function was evaluated with Harris score, the prosthetic location and prosthetic loosening were observed by pelvic orthophoric radiograph. Results The average operation time of the patients was（ 114.3± 38.9） minutes, and the average intraoperative blood loss was（496.1 -322.4） mL. The average Harris score of hip joint was 38.9±11.9 before operatlon,and it was 93.2± 14.6 at the time of 12 months after operation,the Harris score after operation was significantly higher than that before operation（ t = - 2. 689 ,P = 0.008 ）. The average acetabular ante- version was 18.0° ＋7.6°, and the average acetabular abduction was 46, 1°± 8.5°. There was no significant correlation be- tween body mass index and intraoperative blood loss and the acetabular anteversion （r --0. 102, P = 0. 089;r = 0.112, P = 0. 075 ） , but there was weak positive correlation between body mass index and operation time （ r = 0. 178,P = 0. 036 ） and ace- tabular abduction（ r =0. 154,P = 0. 028 ）. Operation time decreased with the increase of the number of surgical cases. Nerve injury around operative incision occurred in 2 cases during operation（ 3.8% ） , and proximal femoral fracture occurred in 2 ca- ses. After operation,the deep venous thrombosis occurred in 3 cases （5.6%）, and dislocation of hip joint occurred in 3 cases （5.6%）. The complication incidence rate was 20.8%. Conclusions THA with direct anterior minimally invasive approach can reduce wound, shorten operation time, quicken postoperative recovery, keep the normal tension of muscles around hip, and maintain hip joint stabilization. In order to avoid complications and obtain favourable effects, the doctors should master the sur- gical technic of direct anterior minimally invasive approach in THA.