改良Watson-Jones入路与改良Hardinge 入路全髋关节置换术的疗效比较

目的 比较改良Watson-Jones入路与改良Hardinge入路全髋关节置换术(THA)的疗效.方法 对2005年1月至2008年2月行THA治疗且获得随访的90例患者资料进行回顾性研究,其中采用改良Watson-Jones入路行微创THA(A组)44例,男20例,女24例；平均年龄(68.2±8.0)岁.病因:股骨颈骨折23例,股骨头坏死9例等.采用改良Hardinge入路行THA(B组)46例,男21例,女25例；平均年龄(69.1±9.2)岁.病因:股骨颈骨折21例,股骨头坏死6例等.手术均由同一组医生完成.临床评估包括术后3个月和末次随访时Harris髋关节功能评分及Barthel指数等,放射学评估包括髋臼外展角,记录并发症的发生情况.结果 所有患者术后获平均(50.9±10.1)个月随访.A组患者切口长度较B组短,失血量较B组少,术后3d内下床例数较B组多,两组比较差异均有统计学意义(p＜0.05).两组患者髋臼外展角差异无统计学意义(P＞ 0.05).术后3个月A组患者Harris评分[(82.4±3.3)分]及Barthel指数(85.4±3.8)均高于B组患者[(72.3±3.7)分、77.2±5.4],差异均有统计学意义(P＜0.05).但末次随访时两组患者的Harris评分及Barthel指数比较差异均无统计学意义(P＞0.05).两组患者均末出现伤口感染、假体松动、髋关节脱位、血管神经损伤或深静脉血栓形成等并发症.结论 改良Watson-Jones入路与改良Hardinge入路均能满意应用于THA,但改良Watson-Jones入路微创THA术后前3个月内功能恢复更佳.

Modified Watson-Jones approach versus modified Hardinge approach for total hip arthroplasty

Objective To compare clinical results of modified Watson-Jones minimally invasive approach and modified Hardinge approach in total hip arthroplasty(THA).Methods This study reviewed 90 patients who had undergone THA from January 2005 through February 2008.The modified Watson-Jones approach was used in 44 patients(group A),20 men and 24 women,with an average age of 68.2 ±8.0 years; the modified Hardinge approach was used in 46 patients(group B),21 men and 25 women,with an average age of 69.1 ± 9.2 years.The causes of THA were mostly femoral neck fracture(23 cases in group A and 21 cases in group B)and femoral head necrosis(9 cases in group A and 6 cases in group B).All the operations were performed by the same group of surgeons.Clinical evaluation involved the Harris hip scores and Barthel indexes at 3 months and the final follow-up.Radiographs were evaluated to examine the acetabular abduction angle.Complications in both groups were recorded.Results The patients had an average follow-up of 50.9 ± 10.1 months.Group A were significantly superior to group B in incision length,blood loss and ambulant patients within 3 days postoperation(P ＜ 0.05).There was no significant difference between the 2 groups in the acetabular abduction angle.At 3 months postoperation,the mean Harris hip score(82.4 ±3.3)and Barthel index(85.4±3.8)were significantly higher in group A than in group B(72.3 ±3.7 &77.2 ± 5.4)(P ＜ 0.05),but such significant differences between the 2 groups were not observed at the final follow-up(P ＞ 0.05).Complications,such as wound infection,hip dislocation,vascular and neural lesions,and deep vein thrombosis,did not occur in either group.Conclusion Both modified Watson-Jones minimally invasive approach and modified Hardinge approach can be successfully used for total hip replacement,but the former can lead to better functional recovery at 3 months after operation.