微创前外侧入路和后外侧入路初次全髋关节置换术近期疗效对比

Comparison of recent effectiveness of primary total hip replacement via orthop dische chirurgie münchen approach and versus posterior lateral approach

摘要:

目的：比较微创前外侧入路（orthop dische chirurgie München，OCM）与常规后外侧入路（posterolateral approach，PLA）在初次全髋关节置换中的早期临床疗效。方法：分析2014年8月至2016年10月重庆市第四人民医院收治的82例行初次全髋关节置换术患者，根据入路方式不同随机分为OCM组与PLA组，分别对2组的切口长度、手术时间、手术总出血量、输血率、术后开始下床时间、术前与术后髋关节Harris评分、疼痛视觉模拟评分（visual analogue scores，VAS）、术后放射学检查假体位置等进行对比评估。结果：2组在切口长度，手术时间，手术总出血量，术后开始下床时间，术后24 h、48 h、72 h VAS及术后1周、1个月、3个月Harris评分比较，差异均有统计学差异（P<0.05）；而2组输血率，术后1周VAS，术后6个月、12个月、24个月髋关节Harris评分及假体位置无统计学差异（P<0.05）。2组患者均无脱位情况发生，OCM组患者1例（0.71%）术中发生股骨距骨折，经钢丝环扎固定处理，随访过程显示假体稳定，无松动、下沉。结论：与PLA入路比，OCM入路初次全髋关节置换切口小，出血少，早期临床效果更佳。

Abstract:

Objective：To compare the clinical outcome of primary total arthroplasty via orthop dische chirurgie München（OCM） and traditional posterolateral approach（PLA）. Methods：A total of 82 patients underwent total hip arthroplasty in our hospital from August 2014 to October 2016 were randomly divided into the OCM group and the PLA group in accordance with different approaches. The length of incision，operating time，gross blood loss，blood transfusion rate，postoperative off-bed time，preoperative and postoperative Harris score of hip joint，visual analogue scores（VAS） and postoperative radiological positioning of implants were compared and assessed. Results：Statistical significant differences were found between two groups in the length of incision，operating time，gross blood loss，off-bed time，VAS at 24 h，48 h and 72 h，and postoperative Harris scores of hip joint at the 1st week，the 1st month and the 3rd month（P<0.05），while no statistical significant differences were found between two groups in the rate of blood transfusion，postoperative VAS at the 1st week，postoperative Harris scores of hip joint at the 6th month，the 12th month and the 24th month，and implants position（P>0.05）. No postoperative dislocation was observed during follow up. However，one femoral calcar fracture happened intraoperatively in the OCM group（0.71%） which was fixed with steelwire cerclage，and was stable during the follow-up，without loosening and subsidence. Conclusion：Compared with the PLA，the OCM approach for primary total arthroplasty has advantages of shorter incision length，less bleeding and better clinical outcomes in early stages.