Musil D, Stehlík J, Verner M
Ortopedické oddelení Nemocnice Ceské Budejovice, a. s.
Acta Chir Orthop Traumatol Cech. 2008 Feb;75(1):16-20.
The aim of this prospective randomized study was to compare, by means of biochemical markers, the operative invasiveness of the standard total hip replacement with that of the minimally invasive anterolateral (MIS-AL) approach.
Twenty-six randomly assigned patients with standard and 22 patients with MIS-AL total hip replacement were included in the study. Patients with elevated pre-operative levels of the markers evaluated or patients taking medication that might affect marker levels were not included.
Creatine phosphokinase (CPK) and C-reactive protein (CRP) were chosen as markers of muscle damage and post-operative inflammatory changes, respectively. Blood samples were drawn before surgery (less than 24 hours) and after surgery at 24, 48 and 96 hours, which respected biological half-lives of the markers and permitted us to study their dynamics. The results were evaluated and statistically analyzed at the department of biochemistry, using the two sample t-test.
Statistically significant differences between the two groups of patients were found for both markers. The average CRP values differed significantly (p < 0.05) at 48 and 96 hours post-operatively, being higher for the standard than MIS-AL total hip replacement by 28% and 44%, respectively. The average CPK values showed the most marked difference at 48 hours after surgery, when the level was higher by 62.5% in the standard than MIS-AL total hip replacement (p < 0.05).
Our objective evaluation of the invasiveness of surgery in total hip replacement was based on the most frequently recommended markers for assessment of muscle tissue damage and post-operative inflammatory changes. The study was focused on the invasiveness of surgery only and neither subjective nor objective outcomes of implantation were evaluated. The use of the muscle sparing approach MIS-AL results in minimal damage to muscle tissue and, consequently, a lower degree of post-operative inflammation than is recorded in traditional hip replacement surgery.
In the patients undergoing MIS-AL total hip replacement, post-operative levels of CPK and CRP were significantly lower than in the patients with standard total hip replacement. The MIS-AL technique evidently provides a more sparing approach to soft tissues.
本前瞻性随机研究旨在通过生化标志物比较标准全髋关节置换术与微创前外侧（MIS-AL）入路手术的侵袭性。
本研究纳入了26例随机分配接受标准全髋关节置换术的患者和22例接受MIS-AL全髋关节置换术的患者。术前评估的标志物水平升高的患者或正在服用可能影响标志物水平药物的患者未被纳入。
分别选择肌酸磷酸激酶（CPK）和C反应蛋白（CRP）作为肌肉损伤和术后炎症变化的标志物。在手术前（少于24小时）以及术后24、48和96小时采集血样，这符合标志物的生物半衰期，使我们能够研究它们的动态变化。结果在生物化学科进行评估并使用两样本t检验进行统计分析。
两组患者的两种标志物均存在统计学上的显著差异。术后48小时和96小时，平均CRP值存在显著差异（p < 0.05），标准全髋关节置换术的平均CRP值分别比MIS-AL全髋关节置换术高28%和44%。平均CPK值在术后48小时差异最为显著，此时标准全髋关节置换术的水平比MIS-AL全髋关节置换术高62.5%（p < 0.05）。
我们对全髋关节置换术手术侵袭性的客观评估基于最常推荐的用于评估肌肉组织损伤和术后炎症变化的标志物。该研究仅关注手术的侵袭性，未评估植入的主观或客观结果。采用保留肌肉的MIS-AL入路对肌肉组织的损伤最小，因此术后炎症程度低于传统髋关节置换手术。
接受MIS-AL全髋关节置换术的患者术后CPK和CRP水平明显低于接受标准全髋关节置换术的患者。MIS-AL技术显然对软组织的损伤更小。
