Ward Samuel R, Jones Richard E, Long William T, Thomas Debra J, Dorr Lawrence D
Department of Radiology, University of California San Diego, San Diego, California, USA.
Instr Course Lect. 2008;57:249-54.
Whether mini-incision total hip arthroplasty is associated with accelerated postoperative recovery is a subject of considerable controversy. A study was conducted to compare objective outcomes using gait analysis as a measure for recovery of function in patients treated with three different minimally invasive surgical approaches and the traditional posterior approach. Sixty-nine patients underwent instrumented gait analysis at self-selected and fast velocities preoperatively and at 6 weeks and 3 months postoperatively. Four surgical groups were studied-30 treated with posterior mini-incisions, 11 anterolateral, 10 anterior Judet, and 18 traditional posterior long incisions. Overall, gait velocity increased slightly at 6 weeks and significantly at 3 months. However, there were no significant differences between groups for velocity, cadence, stride length, single-limb support time, or double-limb support time at 6 weeks or 3 months postoperatively. These data indicate that patients undergoing total hip arthroplasty with any of these surgical approaches recover muscle function, as measured by gait analysis, to preoperative levels within 6 weeks postoperatively. No advantage was shown with the use of any of the three different small-incision approaches. This finding suggests that the amount of muscle, or the particular muscle cut, does not have a significant effect on the recovery of postoperative gait function.
微创全髋关节置换术是否与术后恢复加速相关是一个颇具争议的话题。开展了一项研究，以步态分析作为衡量三种不同微创手术方法及传统后入路手术治疗患者功能恢复的指标，比较客观结果。69例患者在术前、术后6周和3个月时，以自选速度和快速速度接受仪器化步态分析。研究了四个手术组——30例接受后小切口手术、11例接受前外侧手术、10例接受前Judet手术以及18例接受传统后长切口手术。总体而言，步态速度在术后6周略有增加，在3个月时显著增加。然而，术后6周或3个月时，各手术组在速度、步频、步长、单腿支撑时间或双腿支撑时间方面并无显著差异。这些数据表明，采用上述任何一种手术方法进行全髋关节置换术的患者，通过步态分析测量，术后6周内肌肉功能恢复至术前水平。三种不同小切口手术方法均未显示出优势。这一发现表明，肌肉量或特定肌肉的切断对术后步态功能恢复没有显著影响。
