Sander K, Layher F, Babisch J, Roth A
am Waldkrankenhaus Rudolf Elle GmbH, Lehrstuhl für Orthopädie des Universitätsklinikums Jena, Eisenberg.
Z Orthop Unfall. 2011 Apr;149(2):191-9. doi: 10.1055/s-0030-1250590. Epub 2011 Jan 17.
In a prospective study the results of total hip replacement of patients with coxarthrosis and minimally invasive anterolateral (MIS; n = 48) vs. conventional transgluteal approach (KONV; n = 10) were investigated by means of clinical and functional outcomes. Different clinical scores and gait parameters were compared with each other preoperatively and on average 5 weeks and 6 months postoperatively as well as to a control group (VG; n = 58) of healthy age-matched probands.
For clinical examination the range of hip motion was determined and the Harris hip score (HHS), the score according to Merle d'Aubigné (MD), the intensity of pain (visual analogue scale - VAS), the SF-36 and the WOMAC arthrosis index have been used. Furthermore, the subjective gait pattern was interpreted and the Trendelenburg sign was analysed. The influence of the implantation on the biomechanics of the joint was estimated with a biomechanical score by analysing the pelvic radiographs. Objective measurement data of the gait were obtained by using a three-dimensional motion analysis system with six infrared cameras and three force plates.
Both groups of patients had good clinical results at five weeks after surgery, especially shown in the significantly better results of the used pain scores. Despite visually inconspicuous gait in both operated groups, the sensitive parameters of the gait analysis showed persistent large deficits. A significant improvement was appreciated six months after surgery, but the level of the healthy probands was not attained at this time. There were no significant differences of any gait parameter between the groups MIS and KONV at any time of examination.
Advantages of minimally invasive approaches in total hip replacement which can be found a short time after surgery (like less blood loss, less pain after operation, quicker beginning of mobilisation) were not found in this study 5 weeks later regarding functional outcomes. Persistence of functional deficits, caused by damage to the arthromuscular complex, which occur during the process of the development of the arthrosis, need much more time to recover after surgery, independent of the used approach.
在一项前瞻性研究中，通过临床和功能结果调查了髋关节骨关节炎患者采用微创前外侧入路（MIS；n = 48）与传统经臀入路（KONV；n = 10）进行全髋关节置换的结果。将不同的临床评分和步态参数在术前、术后平均5周和6个月时相互比较，并与年龄匹配的健康对照组（VG；n = 58）进行比较。
临床检查测定髋关节活动范围，并使用Harris髋关节评分（HHS）、Merle d'Aubigné评分（MD）、疼痛强度（视觉模拟量表 - VAS）、SF - 36和WOMAC骨关节炎指数。此外，对主观步态模式进行解读并分析Trendelenburg征。通过分析骨盆X线片，用生物力学评分评估植入物对关节生物力学的影响。使用带有六个红外摄像头和三个测力板的三维运动分析系统获取步态的客观测量数据。
两组患者术后5周均取得了良好的临床效果，尤其在所用疼痛评分的显著更好结果中得以体现。尽管两个手术组的步态在视觉上不明显，但步态分析的敏感参数显示持续存在较大缺陷。术后6个月有显著改善，但此时未达到健康对照组的水平。在任何检查时间，MIS组和KONV组之间的任何步态参数均无显著差异。
本研究未发现全髋关节置换中微创入路在术后5周时具有诸如失血少、术后疼痛轻、更早开始活动等优势。由骨关节炎发展过程中关节肌肉复合体损伤导致的功能缺陷持续存在，手术后需要更多时间恢复，与所采用的入路无关。
