改良Watson-Jones入路微创全髋置换术的技术要点及临床应用

目的 探讨改良Watson-Jones(OCM)入路微创全髋置换术的技术要点,观察临床应用效果.方法 2005年1月-2006年12月采用OCM入路微创全髋置换术治疗髋关节损伤及疾病患者35例,其中男16例,女19例;年龄(65.9±6.8)岁;体重指数(24.4±3.2).记录每例患者的切口长度、手术时间、术中及术后输血量、术后住院天数、并发症、假体位置、髋关节功能评分(Harris评分法)等,分析该方法的临床效果.结果 手术切口(8.3±0.9)cm;手术时间(92.1±13.5)min;输血量(300±218.2)ml;髋臼外展角(46.3±2.9)°;术后住院天数(7.9±1.7)d.平均随访17.3个月(6～24个月).前20例患者术后3个月有11例患者主诉臀部疼痛,术后6个月有9例,术后12个月减少到5例;后15例未出现类似症状.无感染、脱位、血管神经损伤或深静脉栓塞等并发症.末次随访Harris评分为(91.3±5.7)分.结论 OCM入路微创全髋置换术创伤小,术后患者康复信心足,辅以适当的功能锻炼可获得较快的恢复.

Clinical application and key points of OCM minimally invasive total hip arthroplasty

Objective To describe detailed key points of minimally invasive total hip arthroplas-ty (MIS-THA) via Watson-Jones (OCM) approach and explore its clinical outcome. Methods From January 2005 to December 2006, MIS-THA via OCM approach was performed in 35 patients including 16 males and 19 females, at age of (65.9±6.8) years. The average body mass index was (24.4±3.2).The length of incision, operation duration, transfusion, complications, postoperative hospital stay, pros-thesis position and Harris score after operation were observed. Results The patients were followed up for 6-24 months (average 17.3 months), which showed that the length of incision was (8.3±0.9) cm,the operation duration of (92.1±13.5) minutes and the blood transfusion of (300±218.2) ml. All prosthesis had a good position with an abduction angle of (46.3±2.9)°. The postoperative hospital stay was (7.9±1.7) days. Of the early 20 patients, 11 patients complained hip pains at 3 months and de-creased to nine patients at 6 months and to five at 12 months. However, the later 15 patients showed no pain, infection, dislocation, deep vein thrombosis, vessel or nerve injury. During the follow-up period,all of the patients had good prosthesis position and rang of hip motion. Harris score was (91.3±5.7) at final follow-up. Conclusion OCM approach for MIS-THA, through the spatium intermusculare be-tween the gluteus medius and musculus tensor fasciae latae, has the advantages of minor tissue trauma and fast functional recovery.