Department of Orthopedic Surgery, Rush University Medical Center, 1653 W. Congress Parkway, Chicago, IL 60612, USA.
J Biomech. 2011 Feb 3;44(3):372-8. doi: 10.1016/j.jbiomech.2010.10.026. Epub 2010 Nov 13.
While others have reported short-term comparisons between various minimally invasive surgical (MIS) approaches to total hip arthroplasty (THA) and their conventional analogues, longer-term data is lacking, as is information indicating whether MIS approaches to THA provide a biomechanically complete recovery. Furthermore, different MIS approaches have not been compared. Our approaches of interest were a one-incision modified Watson-Jones, and a two-incision approach.
(1) There are significant differences in gait recovery patterns between the two surgical groups and (2) THA subjects have significant differences in function one year after surgery compared to control subjects. To test these hypotheses, THA candidates (n=26) were randomized to receive one of these MIS approaches and evaluated preoperatively, and postoperatively at 3 weeks, and at 3, 6 and 12 months. Evaluations included three-dimensional gait analysis and 24-hour step-counts. The same data were obtained from 25 control subjects. Recovery time-course was assessed using repeated measures ANOVA. T-tests were used to compare controls with the pooled group of THA subjects. We found no differences between the two THA surgical groups regarding the time-course of recovery (p≥0.591). Although recovery was statistically complete by 3 months postoperatively for all variables, there were significant differences from controls at 12 months. Most notably, the external hip adduction moment, which reflects hip abductor function, was more than one standard deviation below normal (p<0.001). THA subject inactivity could not explain the gait differences, since one year after surgery daily step counts were not significantly different from controls (p=0.346). More work is necessary to determine ways to improve biomechanical outcomes for today's patients with high expectations for function and implant longevity.
虽然其他人已经报道了各种微创外科（MIS）方法与传统方法治疗全髋关节置换术（THA）的短期比较，但缺乏长期数据，也没有信息表明 MIS 方法是否能提供生物力学上完整的恢复。此外，不同的 MIS 方法尚未进行比较。我们感兴趣的方法是改良的 Watson-Jones 单切口和双切口方法。
（1）两种手术组的步态恢复模式存在显著差异，（2）THA 患者在手术后一年的功能与对照组相比存在显著差异。为了检验这些假设，我们将 26 名 THA 候选者随机分为接受其中一种 MIS 方法，并在术前、术后 3 周、3、6 和 12 个月进行评估。评估包括三维步态分析和 24 小时计步。对 25 名对照组进行了相同的数据采集。使用重复测量 ANOVA 评估恢复时间过程。使用 t 检验比较对照组和 THA 患者的合并组。我们发现两种 THA 手术组在恢复时间过程方面没有差异（p≥0.591）。尽管所有变量在术后 3 个月时在统计学上已完全恢复，但与对照组相比，在 12 个月时仍存在显著差异。最显著的是，髋关节外展肌力矩，反映髋关节外展肌功能，比正常值低一个标准差以上（p<0.001）。THA 患者的不活动不能解释步态差异，因为手术后一年，每天的步数与对照组无显著差异（p=0.346）。需要进一步研究以确定如何改善当今对功能和植入物寿命期望较高的患者的生物力学结果。
