Sun Shihua, Wang Shuanke, Zhao Lin, Wang Xu
Department of Orthopaedic Surgery, the Second Hospital of Lanzhou University, Lanzhou Gansu, 730000, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2009 Jun;23(6):641-3.
To compare the clinical effect of total hip arthroplasty (THA) using posterolateral conventional or minimally invasive incision.
From January 2007 to November 2007, 38 patients (41 hips) were treated with minimally invasive THA (mini-incision group), and 15 patients (15 hips) underwent conventional THA (conventional incision group). Mini-incision group: 23 males (25 hips) and 15 females (16 hips) aged (53.2 +/- 15.5) years old; body mass index (BMI) was 23.4 +/- 3.3; there were 20 cases (20 hips) of femoral neck fracture, 2 cases (2 hips) of primary osteoarthritis, 14 cases (16 hips) of stage III or IV aseptic necrosis of the femoral head, 2 cases (3 hips) of ankylosing spondylitis involving hip joint; Harris hip score was 47.7 +/- 5.5 and the course of disease was (4.5 +/- 4.3) years. Conventional incision group: 7 males (7 hips) and 8 females (8 hips) aged (54.8 +/- 10.8) years old; BMI was 26.1 +/- 5.1; there were 8 cases (8 hips) of femoral neck fracture, 1 case (1 hip) of primary osteoarthritis, 5 cases (5 hips) of stage III or IV aseptic necrosis of the femoral head, 1 case (1 hip) of ankylosing spondylitis involving hip joint; Harris hip score was 51.2 +/- 4.3 and the course of disease was (3.8 +/- 3.7) years. There were no statistically significant differences between two groups in the general information (P > 0.05).
There were statistical differences between two groups in terms of incision length, perioperative blood loss, drainage volume and blood transfusion volume (P < 0.05), and no statistical differences were evident in operative time, abduction angle and the anteversion angle of acetabular cup (P > 0.05). All incisions healed by first intention and no early postoperative complications occurred. Two groups were followed for 12-22 months (average 18.3 months). All patients walked without the crutch at 2-3 months after operation. The Harris score of the mini-incision group and the conventional incision group 6 months after operation was 88.6 +/- 3.6 and 85.8 +/- 3.3, respectively, indicating there was no significant difference between two groups (P > 0.05), but there was significant difference between before and after operation (P < 0.05).
Compared with conventional THA, the minimally incisive using posterolateral approach THA has the merits of mini invasion, slight hemorrhage, short hospital stay, minor complication, convenient management of femoral head and accurate prosthesis location. However, strict attention should be paid to operative indications.
比较采用后外侧传统切口与微创切口行全髋关节置换术（THA）的临床效果。
2007年1月至2007年11月，38例患者（41髋）接受微创THA治疗（微创切口组），15例患者（15髋）接受传统THA治疗（传统切口组）。微创切口组：男性23例（25髋），女性15例（16髋），年龄（53.2±15.5）岁；体重指数（BMI）为23.4±3.3；股骨颈骨折20例（20髋），原发性骨关节炎2例（2髋），股骨头Ⅲ期或Ⅳ期无菌性坏死14例（16髋），累及髋关节的强直性脊柱炎2例（3髋）；Harris髋关节评分47.7±5.5，病程（4.5±4.3）年。传统切口组：男性7例（7髋），女性8例（8髋），年龄（54.8±10.8）岁；BMI为26.1±5.1；股骨颈骨折8例（8髋），原发性骨关节炎1例（1髋），股骨头Ⅲ期或Ⅳ期无菌性坏死5例（5髋），累及髋关节的强直性脊柱炎1例（1髋）；Harris髋关节评分51.2±4.3，病程（3.8±3.7）年。两组一般资料比较差异无统计学意义（P＞0.05）。
两组在切口长度、围手术期失血量、引流量及输血量方面比较差异有统计学意义（P＜0.05），手术时间、外展角度及髋臼杯前倾角比较差异无统计学意义（P＞0.05）。所有切口均一期愈合，术后早期无并发症发生。两组随访12～22个月（平均18.3个月）。所有患者术后2～3个月弃拐行走。微创切口组与传统切口组术后6个月Harris评分分别为88.6±3.6和85.8±3.3，两组比较差异无统计学意义（P＞0.05），但与术前比较差异有统计学意义（P＜0.05）。
与传统THA相比，后外侧入路微创THA具有创伤小、出血少、住院时间短、并发症少、股骨头处理方便及假体定位准确等优点。但应严格掌握手术适应证。
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