Pagnano Mark W, Trousdale Robert T, Meneghini R Michael, Hanssen Arlen D
Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, USA.
J Bone Joint Surg Am. 2008 May;90(5):1000-6. doi: 10.2106/JBJS.G.00804.
It has been claimed that the two-incision total hip arthroplasty technique provides quicker recovery than other methods do. To date, however, there have been no studies that have directly compared the two-incision technique with another method in similar groups of patients managed with the same advanced anesthetic and rehabilitation protocol. We posed the hypothesis that patients managed with two-incision total hip arthroplasty would recover faster than those managed with mini-posterior-incision total hip arthroplasty and designed a randomized controlled trial specifically (1) to determine if patients recovered faster after two-incision total hip arthroplasty than after mini-posterior-incision total hip arthroplasty as measured on the basis of the attainment of functional milestones that reflect activities of daily living, (2) to determine if the general health outcome after two-incision total hip arthroplasty was better than that after mini-posterior-incision total hip arthroplasty as measured with Short Form-12 (SF-12) scores, and (3) to evaluate the surgical complexity of the two procedures on the basis of the operative time and the prevalence of early complications.
Between November 2004 and January 2006, seventy-two patients undergoing total hip arthroplasty were randomized to two treatment groups: one group was managed with the two-incision technique, and the other group was managed with the mini-posterior-incision technique. The two-incision group comprised thirty-six patients (twenty men and sixteen women) with a mean age of sixty-seven years and mean body mass index of 28.7. The mini-posterior-incision group comprised thirty-six patients (twenty men and sixteen women) with a mean age of sixty-six years and a mean body mass index of 30.2. All patients received the same design of uncemented acetabular and femoral components and were managed with the same comprehensive perioperative pain management and rapid rehabilitation protocol. Operative times and complications were recorded. At two months and one year, all patients were assessed with regard to functional outcome and general health outcome.
The patients in the two-incision group recovered more slowly than did those in the mini-posterior-incision group as measured on the basis of the mean time to discontinue a walker or crutches, to discontinue all walking aids, and to return to normal daily activities. The clinical outcome as measured on the basis of the SF-12 scores was similar at both two months and one year postoperatively. The two-incision total hip arthroplasty was a more complex surgical procedure, with a mean operative time that was twenty-four minutes longer; however, the rate of complications (2.8%; one of thirty-six) was the same in the two groups.
Our hypothesis that the two-incision technique for total hip arthroplasty would substantially improve the short-term recovery after total hip arthroplasty compared with the mini-posterior incision technique was not proved; instead, the patients managed with the mini-posterior-incision technique had the quicker recovery.
据称，两切口全髋关节置换术比其他方法恢复得更快。然而，迄今为止，尚无研究在采用相同先进麻醉和康复方案治疗的相似患者组中，将两切口技术与另一种方法进行直接比较。我们提出假设，采用两切口全髋关节置换术治疗的患者比采用小后外侧切口全髋关节置换术治疗的患者恢复得更快，并专门设计了一项随机对照试验，（1）以确定两切口全髋关节置换术后患者在反映日常生活活动的功能里程碑实现情况方面，是否比小后外侧切口全髋关节置换术后恢复得更快，（2）以确定两切口全髋关节置换术后的总体健康结局是否比小后外侧切口全髋关节置换术后更好，采用简短健康调查问卷12项（SF - 12）评分进行衡量，以及（3）根据手术时间和早期并发症发生率评估两种手术的复杂性。
2004年11月至2006年1月期间，72例行全髋关节置换术的患者被随机分为两个治疗组：一组采用两切口技术治疗，另一组采用小后外侧切口技术治疗。两切口组包括36例患者（20例男性和16例女性），平均年龄67岁，平均体重指数28.7。小后外侧切口组包括36例患者（20例男性和16例女性），平均年龄66岁，平均体重指数30.2。所有患者均接受相同设计的非骨水泥髋臼和股骨假体，并采用相同的围手术期综合疼痛管理和快速康复方案。记录手术时间和并发症情况。在术后2个月和1年时，对所有患者进行功能结局和总体健康结局评估。
以停用助行器或拐杖、停用所有助行工具以及恢复正常日常活动的平均时间衡量，两切口组患者比小后外侧切口组患者恢复得更慢。术后2个月和1年时，基于SF - 12评分衡量的临床结局相似。两切口全髋关节置换术是一种更复杂的手术，平均手术时间长24分钟；然而，两组的并发症发生率相同（2.8%；36例中有1例）。
我们关于全髋关节置换术的两切口技术与小后外侧切口技术相比能显著改善全髋关节置换术后短期恢复的假设未得到证实；相反，采用小后外侧切口技术治疗的患者恢复更快。
