Xu Yipeng, Sun Shaoting, Wang Jiajia, Zhang Haining
Department of Joint Surgery, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266000, P.R.China.
Department of Nephrology, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266000, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2017 Apr 15;31(4):397-403. doi: 10.7507/1002-1892.201610104.
To compare the early effectiveness between by anterior approach via Bikini incision and by OCM approach in the primary total hip arthroplasty (THA).
Between June 2015 and March 2016, 60 patients with ischemic necrosis of the femoral head who accorded with the inclusion criteria were chosen in the study, who were divided into 2 groups according to different surgical approaches. THA was performed on 30 patients by anterior approach via Bikini incision (group A), and on 30 patients by OCM approach (group B). There was no significant difference in age, gender, body mass index, side of affected hip, Steinberg stage of ischemic necrosis of femoral head, preoperative hemoglobin, preoperative Harris score, and preoperative visual analogue scale (VAS) between 2 groups ( >0.05). The operation time, length of incision, intraoperative blood loss, transfusion rate, starting time of straight leg raising exercise, starting time of active abduction of hip, hospitalization time, the incidence of limb length discrepancy, postoperative Harris score and VAS score were recorded and compared between 2 groups. Anteroposterior pelvic X-ray films were taken to measure acetabular abduction and acetabular anteversion.
Primary healing of incision was obtained in all patients of 2 groups, and there was no significant difference in complication between 2 groups ( =0.144， =0.704). All the patients of 2 groups were followed up 3 to 12 months, averaged 6 months. There was no significant difference in operation time, length of incision, intraoperative blood loss, transfusion rate, hospitalization time, and starting time of straight leg raising exercise between 2 groups ( >0.05). Group A was significantly shorter than group B in starting time of active abduction of hip ( =-4.591, =0.000), and was significantly lower than group B in the incidence of limb length discrepancy ( =5.455, =0.020). After operation, neither Harris score at 2 weeks, 6 weeks, 3 months, and 6 months nor VSA score at 24 hours and 6 weeks showed significant difference between 2 groups ( >0.05). The anteroposterior pelvic X-ray films showed that all the prostheses were in good position, and there was no femoral prosthesis subsidence, acetabular cup displacement or dislocation. No significant difference was found in acetabular abduction and acetabular anteversion at 2 days after operation between 2 groups ( =0.887, =0.379; =0.652, =0.517).
Both of two approaches in THA can avoid muscle damage and achieve favorable short-term effectiveness. But, anterior approach via Bikini incision is superior to OCM approach in starting time of active abduction of hip and the incidence of limb length discrepancy.
比较比基尼切口前路与OCM入路在初次全髋关节置换术（THA）中的早期疗效。
选取2015年6月至2016年3月符合纳入标准的60例股骨头缺血性坏死患者，根据不同手术入路分为2组。30例患者采用比基尼切口前路行THA（A组），30例患者采用OCM入路行THA（B组）。2组患者在年龄、性别、体重指数、患侧髋关节、股骨头缺血性坏死的Steinberg分期、术前血红蛋白、术前Harris评分及术前视觉模拟评分（VAS）方面差异均无统计学意义（P>0.05）。记录并比较2组患者的手术时间、切口长度、术中出血量、输血率、直腿抬高锻炼开始时间、髋关节主动外展开始时间、住院时间、肢体长度差异发生率、术后Harris评分及VAS评分。拍摄骨盆正位X线片测量髋臼外展和髋臼前倾角。
2组患者切口均一期愈合，2组并发症差异无统计学意义（P=0.144，P=0.704）。2组患者均随访3至12个月，平均6个月。2组患者在手术时间、切口长度、术中出血量、输血率、住院时间及直腿抬高锻炼开始时间方面差异无统计学意义（P>0.05）。A组髋关节主动外展开始时间显著短于B组（P=-4.591，P=0.000），肢体长度差异发生率显著低于B组（P=5.455，P=0.020）。术后2周、6周、3个月及6个月的Harris评分以及术后24小时和6周的VSA评分在2组间差异均无统计学意义（P>0.05）。骨盆正位X线片显示所有假体位置良好，无股骨假体下沉、髋臼杯移位或脱位。2组术后2天髋臼外展和髋臼前倾角差异无统计学意义（P=0.887，P=0.379；P=0.652，P=0.517）。
THA的两种入路均能避免肌肉损伤并取得良好的短期疗效。但比基尼切口前路在髋关节主动外展开始时间和肢体长度差异发生率方面优于OCM入路。
