Department of Orthopaedic Surgery and Traumatology, Isala Clinics, PO Box 10500, 8000 GM Zwolle, The Netherlands.
Clin Orthop Relat Res. 2011 Jan;469(1):200-8. doi: 10.1007/s11999-010-1331-7. Epub 2010 Mar 30.
For total hip arthroplasty (THA), minimally invasive surgery (MIS) uses a smaller incision and less muscle dissection than the classic approach (CLASS), and may lead to faster rehabilitation.
QUESTIONS/PURPOSES: Does minimally invasive hip arthroplasty result in superior clinical outcomes?
In this double-blind randomized controlled trial, 120 consecutive primary noncemented THAs in 120 patients were assigned to one of two groups (MIS or CLASS). The randomization sequence was stratified for two groups of surgeons, ie, those using a posterolateral approach (PL-CLASS or PL-MIS) and those using an anterolateral approach (AL-CLASS or AL-MIS). Length of the incisions was 18 cm for the CLASS procedures. MIS incisions were extended at the skin level to 18 cm at the end of the procedure. The primary end point was the Harris hip score (HHS) at 6 weeks postoperatively. Patient-centered questionnaires were obtained preoperatively and after 6 weeks and 1 year.
For the patients in the MIS group (average 7.8 cm incision length), statistically significant increased mean HHSs were seen compared with the CLASS group at 6 weeks and 1 year. This difference was small and mainly caused by the favorable results of the PL-MIS. In the MIS group, surgical time was longer. A learning curve was observed based on operation time and complication rate. Although not statistically significant, the perioperative complication rate was rather high in the (anterolateral) MIS group.
The minimal invasive approach in THA did not show a clinically relevant superior outcome in the first postoperative year.
Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
对于全髋关节置换术（THA），微创手术（MIS）与传统方法（CLASS）相比，采用更小的切口和更少的肌肉解剖，可能导致更快的康复。
问题/目的：微创髋关节置换术是否能带来更好的临床效果？
在这项双盲随机对照试验中，120 名连续的原发性非骨水泥 THA 患者被随机分为两组（MIS 或 CLASS）。随机序列按两组外科医生分层，即使用后外侧入路（PL-CLASS 或 PL-MIS）和使用前外侧入路（AL-CLASS 或 AL-MIS）的外科医生。CLASS 手术的切口长度为 18cm。MIS 切口在皮肤水平处延长至 18cm，在手术结束时。主要终点是术后 6 周的 Harris 髋关节评分（HHS）。术前、术后 6 周和 1 年获得患者为中心的问卷。
在 MIS 组（平均切口长度 7.8cm）中，与 CLASS 组相比，术后 6 周和 1 年的 HHS 显著增加。这种差异很小，主要是由于 PL-MIS 的良好结果。在 MIS 组中，手术时间较长。基于手术时间和并发症发生率，观察到学习曲线。尽管没有统计学意义，但（前外侧）MIS 组的围手术期并发症发生率相当高。
THA 的微创入路在术后第一年没有表现出明显的临床优势。
一级，治疗研究。有关证据水平的完整描述，请参见作者指南。
