Bostan Bora, Sen Cengiz, Güneş Taner, Erdem Mehmet, Aytekin Kürşat, Erkorkmaz Unal
Department of Orthopedics and Traumatology, Medicine Faculty of Gaziosmanpaşa University, Tokat, Turkey.
Acta Orthop Traumatol Turc. 2009;43(6):464-71. doi: 10.3944/AOTT.2009.464.
We evaluated the clinical and radiographic results of total hip arthroplasties (THA) performed with the minimally invasive anterolateral (MIA) and standard anterolateral (SA) approaches.
We retrospectively reviewed 25 patients (17 women, 8 men; mean age 57.7+/-12.5 years) and 15 patients (11 women, 4 men; mean age 68.9+/-5.5 years) who underwent THA with the SA and MIA approaches, respectively. The mean body mass index was 32.5+/-5.8 kg/m2 in the SA group and 28.7+/-2.7 kg/m2 in the MIA group. The two groups were compared with respect to blood loss, operation time, blood transfusions, and length of hospital stay. Pain was assessed with a visual analog scale (VAS), and functional results were assessed with the Harris hip score (HHS). The SF-36 questionnaire was administered pre- and postoperatively. Radiographic evaluations included femoral and acetabular components and signs of loosening. The mean follow-up was 25.2+/-8.7 months in the SA group and 26.1+/-7.2 months in the MIA group.
The amount of blood loss and blood transfusions were significantly reduced and length of hospital stay was significantly shorter in the MIA group (p<0.001). The mean operation time did not differ between the two groups (p>0.05). Improvements in the VAS and HHS scores were significantly better in the MIA group (p<0.001). Similarly, improvements in all the SF-36 subscales other than general health, mental health, and role-physical subscales were significantly greater in the MIA group. Radiographically, no signs of loosening and osteolysis were seen. Superficial or deep wound infections did not occur.
Compared to the SA approach, the MIA approach in THA operations is associated with shorter hospital stay, reduced blood loss and blood transfusions, better postoperative pain control, and higher levels of improvements in HHS and SF-36 scores.
我们评估了采用微创前外侧（MIA）入路和标准前外侧（SA）入路进行全髋关节置换术（THA）的临床和影像学结果。
我们回顾性分析了分别采用SA入路和MIA入路进行THA的25例患者（17例女性，8例男性；平均年龄57.7±12.5岁）和15例患者（11例女性，4例男性；平均年龄68.9±5.5岁）。SA组的平均体重指数为32.5±5.8kg/m²，MIA组为28.7±2.7kg/m²。比较两组的失血量、手术时间、输血情况和住院时间。采用视觉模拟量表（VAS）评估疼痛，采用Harris髋关节评分（HHS）评估功能结果。术前和术后均进行SF-36问卷调查。影像学评估包括股骨和髋臼组件以及松动迹象。SA组的平均随访时间为25.2±8.7个月，MIA组为26.1±7.2个月。
MIA组的失血量和输血量显著减少，住院时间显著缩短（p<0.001）。两组的平均手术时间无差异（p>0.05）。MIA组的VAS和HHS评分改善明显更好（p<0.001）。同样，MIA组除一般健康、心理健康和角色-身体子量表外的所有SF-36子量表的改善也明显更大。影像学检查未见松动和骨溶解迹象。未发生浅表或深部伤口感染。
与SA入路相比，THA手术中的MIA入路与住院时间缩短、失血量和输血量减少、术后疼痛控制更好以及HHS和SF-36评分改善水平更高相关。
