后外侧微创入路与后外侧常规入路行高龄双极头人工髋关节置换术的比较

Comparison of posterolateral minimally invasive approach with conventional posterolateral approach for bipolar artificial hip replacement in elderly patients: a randomized controlled clinical trial

摘要:

目的 比较后外侧微创入路和传统髋关节后外侧入路进行人工髋关节双极头置换的差异。方法 32例双极头髋关节置换随机分成两组，实验组(n=15)采用后外侧微创入路，对照组(n=17)采用传统髋关节后外侧入路。观察对比两组患者术中出血量、围手术期失血量、手术时间、切口长度、SF-36评分、Harris评分、VAS评分、止痛药使用量、切口周围感染、假体周围感染、深静脉栓塞、肺栓塞、假体位置不良、脱位、假体松动发生率等指标差异。结果 实验组患者的切口长度、手术时间、术中出血量和围手术期出血量明显低于对照组，差异有统计学意义。实验组在术后第2周的Harris评分、SF-36评分显著高于对照组，差异有统计学意义（P<0.05）。两组均未出现感染等术后并发症。结论 后外侧微创入路较传统的后外侧入路具有微创、术后恢复快，围手术期镇痛药使用量较少等优势，但较长的学习曲线和更有限的手术视野对术者团队带来了巨大挑战，需要有更多的数据和更长的随访对这一术式给予评价。

Abstract:

Objective To compare the posterolateral minimally invasive approach with conventional posterior-lateral approach for bipolar artificial hip replacement in elderly patients. Methods Thirty two patients aged 60-80 years scheduled to undergo bipolar artificial hip replacement were divided into two groups randomly. The posterolateral minimally invasive approach was applied in 15 patients(study group) and the conventional posterior-lateral approach was used in 17 patients(control group). The volume of intraoperative blood loss, surgery time, length of incision, SF-36 score, Harris score, VAS score, amount of analgesic, infection of incision, infection around the prosthesis, deep vein thrombosis, pulmonary embolism, prosthetic cacothesis, dislocation, aseptic loosening were recorded and compared between two groups. Results The length of incision, surgery time, the volume of intraoperative blood loss in study group were significantly lower than those in control group(P<0.05). The Harris score and SF-36 score on the second week after the operation in study group were significantly higher than those in control group(P<0.05). No severe complications were found in both groups. Conclusion Compared to conventional posterior-lateral approach, the posterolateral minimally invasive approach in hip arthroplasty has advantage of less invasiveness during surgery, quicker rehabilitation after operation, the less use of the analgesics. But more data and longer follow-up are needed for evaluation of this approach.