摘要
目的：探讨改良外侧入路小切口人工全髋关节置换术的适应证、可行性、技术要点及临床初步结果,为今后的临床工作提供依据. 方法：2003年10月至2009年5月,采用改良外侧入路小切口人工全髋关节置换术治疗髋关节疾病患者26例26髋,同期采用常规外侧入路行人工全髋关节置换术21例21髋.对两组病例的切口长度、手术时间、术中出血量、术后引流量、输血率、使用助步器的时间、并发症、假体位置、术后Harris髋评分进行分析. 结果：术后随访时间9个月至3年,平均为17.4个月.小切口组较常规组在切口长度、术中出血量、术后引流量、输血率、使用助步器的时间等方面有优势且差异显著（P＜0.05）.小切口组术后早期（术后6周）Harris髋评分较常规组高,功能恢复较常规组快.且股骨Q值与术后Harris髋评分具有正相关关系.两组术后早期 X 线片显示假体位置好,无脱位、无髋内或外翻.小切口人工全髋关节置换术组无并发症,常规人工全髋关节置换术组术后1例发生深静脉血栓形成. 结论：改良外侧入路小切口技术可选择性用于部分病例,具有创伤小,出血少,切口小且不影响假体位置,更利于术后恢复,患者易接受,易于临床开展等优点.
Objective To explore the indication, feasibility, the key of operative technique in detail and to summarize the early results in the modified lateral approach mini--incisional total hip arthroplasty surgery（MIS THA）, which could put forward a gist of clinical treatment. Methods From Oct. 2003 to May. 2009, 26 patients （26 hips） were performed with the modified lateral approach MIS THA. For comparison, 21 patlents（21 hips） were performed with standard THA at the same period. The comparative items included incision length, operation time, blood loss, blood transfusion, complica- tion incidence, time of use walking aid, the Harris hip score after the operation. Results All patients were followed from 9 to 36months （mean 17.4 months）. The minimal incision group was found to have a significantly advantages of incision length, blood loss, blood transfusion, time of use walking aids （P〈0.05）. The Harris hip score（HHS）at the early stage after operation was significant statistically difference. It showed that the recovery of function was rapid in MIS THA at the early stage. Femur Q is correlated positively with HHS. The prosthesis position indicated on the radiotelegram was quite well. There was no dislocation, coxa vara or valga. No complications occurred in MIS THA. DVT appeared in one patient with standard THA after operation. Conclusion The MIS THA can be indicated in selected patients with hip disorders. The advantages of MIS THA are leas trumatic, leas blood Joss, good cosmetic incision and rapid recovery of function. It is featured with easier to accept, feasibility and easier to carry out.
关键词
人工全髋关节置换术
改良外侧入路
小切口
total hip arthroplasty surgery
modified lateral approach
minimal incision
