Zhang Xian-long, Wang Qi, Shen Hao, Jiang Yao, Zeng Bing-fang
Department of Orthopaedic Surgery, Shanghai No. Six People's Hospital, Shanghai Jiaotong University, Shanghai 200233, China.
Chin Med J (Engl). 2007 Jul 5;120(13):1131-5.
Total hip arthroplasty (THA) is widely applied for the treatment of end-stage painful hip arthrosis. Traditional THA needed a long incision and caused significant soft tissue trauma. Patients usually required long recovery time after the operation. In this research we aimed to study the feasibility and clinical outcomes of minimally invasive two-incision THA.
From February 2004 to March 2005, 27 patients, 12 males and 15 females with a mean age of 71 years (55 - 76), underwent minimally invasive two-incision THA in our department. The patients included 9 cases of osteoarthritis, 10 cases of osteonecrosis, and 8 cases of femoral neck fracture. The operations were done with VerSys cementless prosthesis and minimally invasive instruments from Zimmer China. Operation time, blood loss, length of incision, postoperative hospital stay, and complications were observed.
The mean operation time was 90 minutes (80 - 170 min). The mean blood loss was 260 ml (170 - 450 ml) and blood transfusion was carried out in 4 cases of femoral neck fracture (average 400 ml). The average length of the anterior incision was 5.0 cm (4.6 - 6.5 cm) and of the posterior incision 3.7 cm (3.0 - 4.2 cm). All of the patients were ambulant the day after surgery. Nineteen patients were discharged 5 days post-operatively and 8 patients 7 days post-operatively. The patients were followed for 18 months (13 - 25 months). One patient was complicated by a proximal femoral fracture intraoperatively. No other complications, including infections, dislocations, and vascular injuries, occurred. The mean Harris score was 94.5 (92 - 96).
Two-incision THA has the advantage of being muscle sparing and minimally invasive with less blood loss and rapid recovery. However, this technique is time consuming, technically demanding, and requires fluoroscopy.
全髋关节置换术（THA）广泛应用于终末期疼痛性髋关节病的治疗。传统的全髋关节置换术需要长切口，会造成显著的软组织创伤。患者术后通常需要较长的恢复时间。在本研究中，我们旨在探讨微创双切口全髋关节置换术的可行性及临床疗效。
2004年2月至2005年3月，我科对27例患者实施了微创双切口全髋关节置换术，其中男性12例，女性15例，平均年龄71岁（55 - 76岁）。患者包括9例骨关节炎、10例骨坏死和8例股骨颈骨折。手术采用Zimmer中国公司的VerSys非骨水泥假体及微创器械进行。观察手术时间、失血量、切口长度、术后住院时间及并发症情况。
平均手术时间为90分钟（80 - 170分钟）。平均失血量为260毫升（170 - 450毫升），4例股骨颈骨折患者进行了输血（平均400毫升）。前切口平均长度为5.0厘米（4.6 - 6.5厘米），后切口平均长度为3.7厘米（3.0 - 4.2厘米）。所有患者术后第一天即可行走。19例患者术后5天出院，8例患者术后7天出院。对患者进行了18个月（13 - 25个月）的随访。1例患者术中发生股骨近端骨折。未发生其他并发症，包括感染、脱位和血管损伤。Harris平均评分为94.5（92 - 96）。
双切口全髋关节置换术具有保留肌肉、微创、失血少及恢复快的优点。然而，该技术耗时较长且技术要求高，还需要使用透视设备。
