改良人工全髋关节置换外侧入路小切口43例

回顾性分析2004-03/2005-03抚顺市中心医院骨外科收治的行小切口人工全髋关节置换患者43例(49髋)，男22例，女21例；年龄22~79岁；均使用非骨水泥型假体，置换前Harris评分(46.2±5.3)分。同期采用常规外侧入路行人工全髋关节置换患者35例43髋，男22例，女13例；年龄31~78岁；16例使用混合型假体(髋臼非骨水泥型，股骨骨水泥型)，其余病例均使用非骨水泥型假体，置换前Harris评分(43.4±4.6)分。比较两组患者的围置换期出血量、置换时间、切口长度、置换后早中期功能恢复情况及假体位置。结果显示两组患者置换均顺利完成，并获得随访，平均13.1个月。小切口人工全髋关节置换组患者围置换期出血量、引流量、输血量和切口长度均比常规人工全髋关节置换组减少，差异有显著性意义(P < 0.05)；置换后6个月Harris评分分别为(89.0±6.1)分和(88.1±7.4)分，两组假体位置均良好。常规人工全髋关节置换组中1例置换后脱位，切开复位，经2周牵引开始功能锻炼，恢复良好；小切口人工全髋关节置换组未发生脱位。提示小切口微创技术可选择性用于部分病例的人工全髋关节置换，创伤小，围置换期出血少，切口小且不影响假体位置，置换后早期功能恢复快，但应严格选择手术适应证。

Modified minimally invasive total hip arthroplasty through a lateral approach in 43 cases

From March 2004 to March 2005, 43 patients (49 hips) admitted to Department of Orthopedic Surgery, Fushun Central Hospital for minimally invasive total hip arthroplasty (THA) were selected, including 22 male and 21 female aged 22-79 years. All patients underwent THA with cementless prosthesis. The preoperative Harris scores were (46.2±5.3). For comparison, 35 patients (43 hips) were selected undergoing standard THA at the same period, including 22 male and 13 female, aged 31-78 years; 16 patients underwent THA with mixed prosthesis (cementless prosthesis for acetabulum; cemented prosthesis for the femur), and the others with cementless prosthesis. Their preoperative Harris scores were (43.4±4.6). The perioperative bleeding, operation time, incision length, postoperative functional recovery, and prosthetic position were compared. The THA was succeeded in all patients, and all subjects were followed up for 13.1 months averagely. The perioperative bleeding, drainage, blood transfusion and incision length in minimally invasive THA group were significantly less than standard group (P < 0.05); the postoperative Harris scores in minimally invasive THA and standard THA groups were (89.0±6.1) and (88.1±7.4) respectively. The prosthetic position was good in both minimally invasive and standard THA. Dislocation appeared in one patient with standard THA at two days after operation and restored by two-week traction and functional exercise. No complications occurred in minimally invasive THA. The minimally invasive THA can be indicated in selected patients with hip disorders. It has small trauma, little blood loss, good cosmetic incision and rapid recovery of function. However, the operation indications should be selected rigidly.