小切口人工全髋置换假体位置的准确性分析

[目的]评价小切口人工全髋关节置换术假体安放位置的准确性.[方法]自2005年9月～2006年3月行后外侧单切口入路小切口人工全髋关节置换术26例30髋和常规切口人工全髋关节置换术34例35髋.小切口组男15例,女11例,平均52±14.4岁,常规切口组男17例,女17例,平均48±11.7岁.比较两组手术时间、术中出血量、术后引流量、输血量、切口长度和并发症,分析术后影像学资料,测量髋臼杯外展角,髋臼杯前倾角,髋关节旋转中心,肢体长度,股骨假体内外翻比例.比较两组患者的临床疗效和假体安放位置的准确性.[结果]两组在年龄、性别、术后引流量、手术时间、体重质量指数无统计学差别.小切口组25例(29髋),常规切口组32例(33髋)随访18～24月(平均20.1个月).小切口组术中出血量(497±64.9 ml)比常规切口组(675±181.4 ml)少(P<0.05).常规切口组术后需要输血量明显增多(P<0.05).两组患者无严重并发症发生.术后测量髋臼杯外展角小切口组37.7°±6.8°,常规切口组40.3°±5.8°;髋臼杯前倾角小切口组10.8°±7.2°, 常规切口组13.2°±8.9°; 髋关节旋转中心平均上移小切口组-1.4±2.5 mm, 常规切口组-1.5±3.8 mm;术后肢体延长小切口组1.1±7.1 mm, 常规切口组1.5±8.4 mm;股骨假体小切口组内翻1例,中置27例,外翻2例; 常规切口组内翻2例,中置30例,外翻3例.两组假体位置相关参数测量数值差别无统计意义.[结论]在合理选择病例,术者具有丰富经验的情况下,小切口人工全髋关节置换术创伤小、出血少,与常规切口手术相比并不影响假体位置的安放.     

小切口全髋关节置换的手术体会

[目的]探讨小切口人工全髋关节置换手术的优缺点。[方法]比较32例37髋小切口人工全髋关节置换术与普通切口人工全髋关节置换术在切口长度、手术时间、术中出血量、术后引流量、住院时间及并发症等方面的异同。[结果]小切口组平均切口长度为7．7cm，普通切口组为11．5cm（P〈0．05）；小切口组平均手术时间为95min，普通切口组为51min（P〈0．05）；小切口组术中平均出血量为380ml，普通切口组为299ml（P〈0．05）；小切口组及普通切口组在术后引流量及住院时间方面无显著性差异（P〉0．05）；小切口组1例术中出现大转子尖骨折、股骨颈截骨过多、髋臼内凸，1例因髋臼安放角度异常于术后第3d出现髋关节脱位，行扩大切口调整髋臼假体角度后恢复正常；普通切口组术中、术后无1例出现并发症。[结论]与普通长度切口全髋关节置换手术相比，小切口手术在出血量、组织损伤程度、手术时间方面并无明显优势；由于切口小，术野受限，手术操作比较困难，易出现假体安装位置异常等问题。在熟练做好普通切口全髋置换手术、不增加手术损伤的前提下，可尽量减小手术切口长度，没有必要刻意追求小切口全髋置换手术。     

计算机导航系统辅助下全髋关节表面置换的初步经验

目的 初步评估计算机辅助下行全髋关节表面置换的手术方法及假体植入的精确性.方法 对40例患者分成导航组(20例)和对照组(20例),分别采用计算机导航系统辅助和标准常规技术完成全髋关节表面置换术.比较两组手术时间、术中失血量、Harris髋关节评分(HHS),以及髋臼杯外展角和前倾角的偏移度及股骨假体柄干角和前倾角的偏移度.结果 手术时间导航组较对照组长38.7min(P＜0.05),术中平均出血量导航组较对照组多109.4 ml(P＜0.05).随访平均14.5个月,HHS评分两组比较差异无统计学意义(P＞0.05).对照组髋臼杯外展角偏移度(7.3°±4.3°)大于导航组(1.9°±1.3°)(P＜0.05),对照组髋臼杯前倾角偏移度(3.9°±2.3°)大于导航组(2.4°±1.5°)(P＜0.05).导航组股骨假体柄干角偏移度(1.5°±1.0°)小于对照组(11.3°±1.3°)(P＜0.05),导航组股骨假体前倾角偏移度(1.8°±2.3°)小于对照组(6.5°±5.3°)(P＜0.05).结论 计算机导航系统辅助下行全髋关节表面置换术可以提高假体植入的精确性,避免股骨颈皮质骨切迹,降低股骨颈骨折的风险.     

虚拟影像导航下微创全髋关节置换的初步报告

目的 探讨虚拟影像导航辅助下微创全髋关节置换的方法和疗效.方法 15例(18髋)在导航系统下进行小切口微创全髋关节表面置换术.术前平均Harris评分35分(25～45分),采用改良Gibson手术入路,统计手术时间、出血量、切口大小.术后进行视觉类比评分、Harris评分分析和X线检查.结果 在导航系统下顺利完成18例微创全髋关节置换,平均手术时间为90 min(80～105min),平均出血量为250 ml(250～350 ml),平均切口长度为7.5～8.5 cm,平均VAS评分为3.5分(1.5～4.5分).术后平均Harris评分为95分(85～100分),优16髋,良2髋.术后髋臼假体前倾角为(15.2±0.8)°,外展角为(44.8±1.2)°.平均随访2.5年(40～15个月),X线摄片发现1例髋臼假体周围出现透亮线,而无松动迹象.结论 手术导航系统的应用解决了小切口微创全髋关节置换中视野的局限,提高了髋臼和股骨假体放置的精确性,减少假体松动的发生,具有重要的临床价值.     

小切口全髋关节置换术治疗髋臼发育不良的临床研究

目的探讨前外侧小切口入路全髋关节置换治疗髋臼发育不良的可行性。方法2004年2月-2008年1月,采用前外侧小切口对30例髋臼发育不良的患者行全髋关节置换术,记录切口长度、出血量、手术时间、术后功能恢复及并发症。结果手术切口长度平均8cm（7—10cm）,手术时间平均80min（70-120min）,出血量平均约300ml（250～660ml）,无严重并发症发生,术后7d负重行走,Harris评分平均92分,优良率93．9％。结论小切口全髋关节置换可选择治疗部分髋臼发育不良患者,具有创伤小、出血少、恢复快等优点。     

小切口全髋关节置换术近期随访观察

[目的]探讨前外侧小切口全髋关节置换术的适应证及临床效果。[方法]自2002年5月-2005年3月，采用前外侧小切口人工全髋关节置换术治疗年龄65～88岁的股骨颈囊内骨折23例，股骨头无菌性坏死11例。[结果]前外侧小切口平均长度7．5cm，手术时间平均75min，平均出血量205ml，无输血及使用镇痛药物，无脱位、感染、深静脉栓塞等并发症。平均随访18个月，X线片未见假体松动下沉表现，Harris评分为92．1分。[结论]前外侧小切口全髋关节置换术适用于髋关节无畸形、髋臼和股骨近端无明显骨质缺损、骨质疏松及过度肥胖的患者。合理的切口及精确的操作可减少手术创伤，有利于功能恢复。     

外侧微创切口全髋关节置换术

目的探讨微创全髋关节置换的可能性和优缺点。方法2004年1月至2004年12月,对22例(26髋)采用侧卧位,大转子前1/3略弧顶向后的纵切口,完成全髋关节置换。记录术前、术后切口长度、术中出血量、手术时间、假体位置、伤口愈合情况和直腿抬起时间。结果所有患者的假体位置良好,4例伤口愈合不良,换药后治愈。手术开始时平均切口长度8.3 cm,手术结束时平均切口长度9.0 cm。平均手术时间87 m in。平均术中出血量145 mL,术后出血量139 mL。直腿抬起时间3.7 d。无假体脱位及骨折等并发症。结论微创全髋关节置换术具有创伤小、出血少、恢复快等优点。7~9 cm伤口足可以顺利完成全髋关节,刻意追求过小切口会导致皮肤及软组织损伤,甚至假体位置异常。     

微创前外侧入路髋关节置换术治疗老年股骨颈骨折

[目的]比较微创半髋(minimally invasive surgery of hemiarthroplasty,MIS-HA)与微创全髋关节置换术(minimally invasive surgery of total hip arthroplasty,MIS-THA)治疗老年股骨颈骨折的短期临床疗效。[方法]对2011年2月²014年4月因股骨颈骨折施行微创前外侧入路髋关节置换的120例患者120髋(年龄>70岁),分为微创半髋组和微创全髋组,各60例60髋,比较两组手术时间、切口长度、围手术期出血量、输血量、血红蛋白含量、住院时间、并发症、VAS疼痛评分、HHS评分及SF-36评分的差异。[结果]平均随访18个月(142014年4月因股骨颈骨折施行微创前外侧入路髋关节置换的120例患者120髋(年龄>70岁),分为微创半髋组和微创全髋组,各60例60髋,比较两组手术时间、切口长度、围手术期出血量、输血量、血红蛋白含量、住院时间、并发症、VAS疼痛评分、HHS评分及SF-36评分的差异。[结果]平均随访18个月(14³2个月)。两组相比手术时间、围手术期出血量,差异有统计学意义(P<0.001)。两组切口长度、输血量、术后血红蛋白含量、住院时间、VAS评分,差异无统计学意义(P>0.05)。但微创全髋组HHS评分和SF-36评分优于微创半髋组,差异有统计学意义(P<0.05)。两组患者均无术中术后骨折、感染、脱位、血管神经损伤、下肢深静脉血栓形成等并发症。[结论]微创前外侧入路全髋关节置换术治疗老年股骨颈骨折,具有创伤小、关节稳定性良好、并发症少、恢复快等优点,适合老年股骨颈骨折(GardenⅢ、Ⅳ型)患者。     

微创技术在人工全髋关节置换术中的应用

目的探讨微创人工全髋关节置换术的优点及手术风险。方法2006年2月至2008年4月，对16例17髋患者行前外侧入路微创人工全髋关节置换术。结果手术切口平均长度9．5cm，平均手术时间75min，术中平均出血量260ml，术后平均引流量170ml。随访12个月未发现Trendelenburg征阳性。结论前外侧入路微创人工全髋关节置换术具有单一切口内完成髋臼和股骨假体安装、不须切断肌肉、手术风险小、并发症少等优点。     

双切口微创全髋关节置换的临床报告

目的介绍双切口微创全髋关节置换的手术方法。方法2004年以来,应用双切口微创全髋关节置换10例。前切口平行股骨颈的体表投影,长4.5cm,从缝匠肌和股外侧肌间隙进入,“工”字形切开关节囊后完成股骨颈截骨,使用特殊的髋臼锉和带偏心距的髋臼打入器安放髋臼,缝合关节囊。髋后切口3.0cm,劈开臀中肌纤维通过套筒股骨扩髓,在X线机透视下安放股骨假体。结果本组患者术中出血量平均为184mL,术后3d下地活动,住院时间平均为7.4d。患者术后随访平均为4.5个月,8例已完全脱拐,行走正常,2例出院不足1个月,仍需扶拐行走。结论双切口全髋关节置换不切断臀中肌,损伤小,保留关节囊,患者功能恢复快,住院时间短。手术适应证为股骨颈骨折或病变较轻、且不过于肥胖的初次置换者,并发症包括髋臼或股骨柄位置不佳和股骨近端骨折。双切口髋关节置换需要一个独立的学习过程,并且需要C型臂X线监视仪和特殊的髋臼锉、打入器等。     

A minimal-incision technique in total hip arthroplasty does not improve early postoperative outcomes. A prospective, randomized, controlled trial

BACKGROUND: Minimally invasive total hip arthroplasty has stirred substantial controversy with regard to whether it provides superior outcomes compared with total hip arthroplasty performed through longer incisions. The orthopaedic literature is deficient in well-designed scientific studies to support the clinical superiority of this approach. The objective of this study was to compare the results of a single mini-incision approach with those of a standard-incision total hip arthroplasty in the early postoperative period. METHODS: Two hundred and nineteen patients (219 hips) admitted for unilateral total hip arthroplasty between December 2003 and June 2004 were randomized to undergo surgery through a short incision of 相似文献   

Early pain relief and function after posterior minimally invasive and conventional total hip arthroplasty. A prospective, randomized, blinded study

BACKGROUND: Few prospective randomized studies have demonstrated benefits of minimally invasive total hip arthroplasty when compared with conventional total hip arthroplasty. We hypothesized that patients treated with a posterior mini-incision would have better results than those treated with a posterior long incision with regard to the achievement of established goals for pain relief and functional recovery permitting hospital discharge by the second postoperative day. METHODS: Sixty of 231 eligible patients were randomized (with thirty in each group) to have a total hip arthroplasty performed through either a posterior mini-incision (10 +/- 2 cm) or a traditional long incision (20 +/- 2 cm). After completion of the total hip arthroplasty, the mini-incision group underwent extension of the skin incision to 20 cm. Patients were evaluated on the basis of self-determined pain scores, requirements for pain medicine, need for assistive gait devices, and time until discharge. Gait analysis provided objective functional assessment. RESULTS: The average hospital stay was 63.2 +/- 13.3 hours in the mini-incision group and 73.6 +/- 23.5 hours in the long-incision group (p = 0.04). More patients with a mini-incision were discharged by the second postoperative day (p = 0.003) and more were using just a single assistive device at the time of discharge (p = 0.005). As scored on a verbal analog scale of 0 to 10 points, patients with a mini-incision had less pain on each postoperative day and the pain score remained significantly lower at the time of discharge (mean, 2.2 +/- 1.0 points compared with 3.1 +/- 0.9 points in the long-incision group; p = 0.002). After hospital discharge, there were no clinical differences in pain or function between the two groups of patients. CONCLUSIONS: Compared with conventional total hip arthroplasty performed through a posterior incision, posterior minimally invasive total hip arthroplasty resulted in better early pain control, earlier discharge to home, and less use of assistive devices. Subsequent evaluations at six weeks and three months showed equivalency between the clinical results in the two groups. LEVEL OF EVIDENCE: Therapeutic Level I.     

小切口微创人工全髋关节置换术的临床应用

目的 探讨后外侧小切口微创(minimally invasive surgery,MIS)人工全髋关节置换术(total hip arthroplasty,THA)的适应证及临床效果.方法 2011年7月至2014年6月本院收治的68例需行THA的患者,随机分为小切口组和常规组,其中小切口组32例,采用后外侧MIS-THA;常规组36例,采用常规THA手术方法.比较两组的手术切口长度、手术时间、手术出血量、手术前后疼痛视觉模拟量表(visual analogue scale,VAS)评分以及Harris评分.结果 小切口组的术后早期VAS评分以及术后1个月Harris评分皆优于常规组,差异有统计学意义(P＜0.05);而在术中出血量、术后引流量、手术时间以及术后3个月Harris评分中并无明显优势.结论 MIS-THA具有关节功能恢复快、组织创伤小、手术切口外形美观等优点,在严格掌握其适应证的情况下,建议推广使用.     

Comparison of primary total hip replacements performed with a standard incision or a mini-incision

BACKGROUND: Primary total hip replacement performed through an incision that is 相似文献   

Comparison of skin blood flow between mini- and standard-incision approaches during total hip arthroplasty

Twenty patients who underwent total hip arthroplasty were randomly allocated to have surgery through a mini incision of < or = 8 cm (mini-incision surgery [MIS] group, n = 10) or a standard incision of 14 cm (standard group, n = 10). A laser Doppler flowmeter was used to measure the intraoperative blood flow of the skin. The measurements were performed at 2 regions, specifically, anterior and posterior regions across the middle points of skin incision. The measurements were taken before making the incision and after implantation. As a control, the skin blood flow over the anterior superior iliac spine was measured. After implantation, mean skin blood flows at both regions in the MIS group were significantly decreased by 32% and 33%. However, the corresponding flows in standard group and control regions were constant during operation.     

Minimally invasive total hip arthroplasty: a prospective randomized study

Patients without prior hip surgery and body mass index lower than 30 undergoing primary total hip arthroplasty were eligible to participate in a randomized prospective study comparing a minimally invasive with a standard approach. The patients were randomized to receive incisions of 8 cm (group A, n = 28) or 15 cm (group B, n = 32). The groups were similar demographically. Patients in group A had significantly less intraoperative blood loss (P < .003) and less total blood loss (P < .009). Fewer patients in group A limped at 6 weeks (P < .04). Operative time, transfusion requirements, narcotic usage, length of hospital stay, achievement of rehabilitation milestones, cane usage, and complications were similar in both groups. There was no difference between the groups at 1- and 2-year follow-up. Compared with a standard incision, patients who underwent a minimally invasive total hip arthroplasty demonstrated decreased blood loss and limped less at 6-week follow-up.     

小切口微创全髋关节置换术早期比较研究

目的：报告后路小切口微创与常规切口全髋关节置换术早期比较结果：方法：自2003年10月～2004年11月，15例患者行单侧后路小切口微创全髋关节置换术，同期24例患者接受常规切口手术，进行术中和术后指标比较：结果：小切口微创手术平均切口长8．3cm，术中出血量373ml，手术时间79min，术后12h引流量219ml。输血6例，平均输血量0．60U。2例发生切口皮肤擦伤：与常规切口手术比较，切口长度和手术时间有显著性差异，术中失血量、术后引流量以及输血量无显著性差异．结论：后路小切口微创全髋置换术具有创伤小、手术时间短等优点，手术切实可行，但要有严格的手术指征、熟练的操作技术和专用的器械。     

A randomised clinical trial comparing minimally invasive surgery to conventional approach for endoprosthesis in elderly patients with hip fractures

Background

In recent years, the concept of minimally invasive surgery has invaded the orthopaedic field and literature on the subject is spawning. Mini-incision surgery for total hip arthroplasty has been studied without a clear consensus on the efficacy, safety and advantage of that technique. To our knowledge, the efficacy and safety of mini-incisions in hip fracture surgery has not been studied in a randomised fashion.

Methods

This study is a prospective clinically randomised trial whose primary objective was to demonstrate the safety and efficacy of a single posterior mini-incision approach compared to a standard posterior approach for endoprosthesis in acute femoral neck fractures. The mini-incision was defined as less than 8 cm. 25 patients in the mini-incision surgery (MIS) group and 31 patients in the standard incision group (STD) were available for analysis. The following validated disease-specific outcome instruments were used: the Lower Extremity Measurement (LEM) and the Time Up and Go (TUG). Secondary endpoints of pain, function, and quality of life were assessed by the components of the Harris Hip Score (HHS) and SF-36. Radiographic outcomes were also evaluated as well as the rates of all reported complications and adverse events during the 2 years follow-up.

Results

There was no significant difference for operative time, blood losses, 72 h postoperative haemoglobin as well as the need for transfusion therapy between the two groups. Also, there was no difference between the groups for postoperative morphine use and pain evaluation with the Visual Analog Scale. The functional assessment using LEM and TUG did not demonstrate any statistically significant difference between mini- and standard incision. However, the HHS and the physical function component of the SF-36 were statistically better at 2 years in favour of the standard incision group.

Conclusion

Based on the results of the present study, we cannot recommend the use of a minimally invasive approach over a standard approach in the implantation of a cemented endoprosthesis.     

Reducing incision length or intensifying rehabilitation: what makes the difference to length of stay in total hip replacement in a UK setting?

Minimal-incision surgery for hip arthroplasty and intensive post-op physiotherapy have both been shown to allow early mobilisation and to reduce hospital stay. Forty-five patients undergoing primary total hip arthroplasty using a standard posterior approach were compared with 51 patients using a minimal incision. In both groups, physiotherapy involved either a routine or intensive regime. Patients were matched in age, sex and body mass index. There was no significant difference in blood loss, post-operative stay and change in Oxford hip scores at one year between the mini- and standard-incision groups. There was a significant difference (P=0.003) in length of stay between routine- and intensive-physiotherapy groups (11.4 vs. 7.9 days). The dislocation rate was higher in the mini-incision group. This study suggests that in a standard UK setting, intensive physiotherapy can significantly decrease in-patient stay, but reducing the incision length does not.     

Minimally invasive uncemented total hip arthroplasty through an anterolateral approach with a shorter skin incision

Total hip arthroplasty using a short skin incision has been associated with great controversy. It has still not yet been demonstrated that a shorter skin incision is efficient or safe for patients. Here, we review 212 cases of uncemented total hip arthroplasty performed since 1999 using the anterolateral approach and a shorter skin incision. Patients were divided into three groups according to the length of the incision at the end of surgery; incisions of 10cm or less were defined as mini (n = 115) and incisions of 10–15cm as short (n = 70); these two groups were defined as shorter skin incision groups. Incisions longer than 15cm in patients undergoing the standard procedure were defined as conventional and served as the controls (n = 27). Statistically significant differences were found with regard to operative duration and intraoperative blood loss: the shorter the length of the incision, the shorter the operative duration and the smaller the intraoperative blood loss. There was no significant difference in postoperative bleeding or in the incidence of complications among the three groups. Total blood losses in the shorter groups were each statistically significant less than that in the conventional group. Comparing the mini group to the short group, the length of the skin incision was influenced by the body mass index (BMI) and gender. For those with a high BMI and for male patients, a slightly longer incision was necessary. We concluded that total hip arthroplasty through a mini or short incision was indeed efficient for patients compared with total hip arthroplasty using a conventional incision.