Rittmeister M, Peters A
Klinik für Orthopädie und Unfallchirurgie, Katharina Kasper gGmbH, St. Marien Krankenhaus, Richard Wagner Strasse 14, 60318, Frankfurt/M., Germany.
Orthopade. 2006 Jul;35(7):716, 718-22. doi: 10.1007/s00132-006-0963-5.
Surgical approaches to the hip for total hip arthroplasty (THA) are termed minimally invasive when allowing for a skin incision length of 10 cm or less. The aim of this study was to explore if a minimally invasive posterior approach compared to a classic anterolateral approach negatively influenced surgical time, blood loss, implant position, or perioperative complications. Two groups of THA patients mainly differing with respect to the surgical approach were compared. Results of 76 consecutive THA via a posterior mini-incision approach were recorded prospectively and those of 76 controls operated via a classic anterolateral approach were recorded retrospectively. THA was performed by the same surgeon in every case. Surgical time or intraoperative blood loss were not different among the groups. Total 24-h blood loss was significantly less in patients undergoing THA via minimally invasive posterior approaches. Median cup inclination was 45 degrees in both groups. Cup anteversion was 15 degrees (classic anterolateral) and 12 degrees (minimally invasive posterior), respectively. Stem position was regarded as neutral in 80% of THA through classic anterolateral and in 76 % through minimally invasive dorsal incisions. Complications occurred in 8% (classic anterolateral) and 9% (minimally invasive posterior) of THA patients. Surgical time, blood loss, risk of malpositioned implants, or complications were not increased for THA patients operated through minimally invasive posterior incisions compared to those operated via classic anterolateral approaches.
对于全髋关节置换术(THA)而言,当皮肤切口长度允许在10厘米或更短时,髋关节的手术入路被称为微创。本研究的目的是探讨与经典前外侧入路相比,微创后外侧入路是否会对手术时间、失血量、植入物位置或围手术期并发症产生负面影响。比较了两组主要在手术入路方面存在差异的THA患者。前瞻性记录了76例通过后外侧小切口入路进行THA的结果,回顾性记录了76例通过经典前外侧入路进行手术的对照组的结果。每例THA均由同一位外科医生实施。两组之间的手术时间或术中失血量并无差异。通过微创后外侧入路进行THA的患者24小时总失血量显著更少。两组髋臼杯倾斜度的中位数均为45度。髋臼杯前倾角分别为15度(经典前外侧入路)和12度(微创后外侧入路)。通过经典前外侧入路进行的THA中,80%的股骨柄位置被视为中立;通过微创后外侧切口进行的THA中,76%的股骨柄位置被视为中立。THA患者中,经典前外侧入路组并发症发生率为8%,微创后外侧入路组为9%。与通过经典前外侧入路进行手术的THA患者相比,通过微创后外侧切口进行手术的THA患者的手术时间、失血量、植入物位置不当风险或并发症并未增加。